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Kadoi Y, Ohta J, Sasaki Y, Saito S. Adequate Oxygenation State Maintained during Electroconvulsive Therapy in Nonobese Patients Using the Oxygen Reserve Index: A Pilot Study. Case Rep Anesthesiol 2023; 2023:7807693. [PMID: 37965073 PMCID: PMC10643024 DOI: 10.1155/2023/7807693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023] Open
Abstract
Some controversial reports have observed oxygen desaturation (defined as percutaneous oxygen saturation (SpO2) < 90%) during electroconvulsive therapy (ECT). The purpose of this pilot study was to examine oxygenation states in eight patients during ECT. In addition to the usual hemodynamic monitors and pulse oximeter, the oxygen reserve index (ORi) was monitored using a pulse oximeter. Patients received either no preoxygenation or preoxygenation with 100% oxygen via a tight-fitting mask for 1 or 3 min before induction of anesthesia. ORi increased after preoxygenation. ORi differed significantly between 3 min of preoxygenation and the other two methods before restarting mask ventilation. SpO2 was significantly increased with all methods before stopping manual mask ventilation or before restarting manual mask ventilation compared with that before preoxygenation. No oxygen desaturation was observed at any time with any treatment methods. In nonobese patients, the adequate oxygenation state as shown by SpO2 and ORi was maintained during ECT even without preoxygenation.
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Affiliation(s)
- Yuji Kadoi
- Division of Operation Room, Gunma University Hospital, Maebashi, Japan
| | - Jo Ohta
- Department of Anesthesiology, Gunma University School of Medicine, Maebashi, Japan
| | - Yumeka Sasaki
- Department of Psychiatry, Gunma University School of Medicine, Maebashi, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University School of Medicine, Maebashi, Japan
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Hardy M, Faber R, Vazquez J, Klinger JE. Prevention of Hypoxia During Electroconvulsive Therapy: Use of Modified Bite Block Combined With Laryngeal Mask Airway. J ECT 2021; 37:148-149. [PMID: 34294648 DOI: 10.1097/yct.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Morgan Hardy
- From the Department of Psychiatry, University of Texas Health San Antonio
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Hasegawa T, Komazawa D, Watanabe Y. Microlaryngeal surgery in severely obese elite vocal performers. Clin Case Rep 2021; 9:e04680. [PMID: 34430028 PMCID: PMC8364936 DOI: 10.1002/ccr3.4680] [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: 06/18/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/09/2022] Open
Abstract
This study showed that microlaryngeal surgery under general anesthesia is feasible for patients with severe obese elite vocal performers if proper simulations are conducted beforehand and the position of the patient and anesthesia is considered.
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Affiliation(s)
- Tomohiro Hasegawa
- Tokyo Voice CenterInternational University of health and WelfareTokyoJapan
| | | | - Yusuke Watanabe
- Tokyo Voice CenterInternational University of health and WelfareTokyoJapan
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de Arriba-Arnau A, Dalmau Llitjos A, Soria V, Menchón JM, Urretavizcaya M. Effective Adaptation of Ventilation Maneuvers in Electroconvulsive Therapy Sessions During the Coronavirus Disease 2019 Pandemic. J ECT 2021; 37:76. [PMID: 34029303 PMCID: PMC8168704 DOI: 10.1097/yct.0000000000000748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/02/2020] [Indexed: 12/05/2022]
Abstract
Supplemental digital content is available in the text.
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Affiliation(s)
- Aida de Arriba-Arnau
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
| | - Antònia Dalmau Llitjos
- Department of Anesthesiology, Reanimation and Pain Clinic, Bellvitge University Hospital–ICS
| | - Virginia Soria
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José Manuel Menchón
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Mikel Urretavizcaya
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
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de Arriba-Arnau A, Dalmau Llitjos A, Soria V, Labad J, Menchón JM, Urretavizcaya M. Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy. Neuropsychiatr Dis Treat 2021; 17:1563-1569. [PMID: 34045858 PMCID: PMC8144845 DOI: 10.2147/ndt.s303877] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/21/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Airway management is a key objective in adapted electroconvulsive therapy (ECT) protocols during the COVID-19 pandemic to prevent infection. The objective of this study was to describe the effectiveness of a modified ventilation procedure designed to reduce aerosol-generating bag-mask ventilation (BMV) and isolate possible droplets while maintaining adequate respiratory gas values in ECT sessions. MATERIALS AND METHODS This prospective study analyzed the results of the modified protocol applied over a month. Adaptations entailed preoxygenation and extension of the voluntary hyperventilation (VHV) time for two minutes before anesthesia induction, asking patients to hyperventilate with oxygen therapy via nasal cannula and while wearing a face mask. Thereafter, vigorous hyperventilation was avoided, and patients were only assisted with tightly sealed BMV until emergence from anesthesia, isolating the ventilation by using a single-use plastic device. Oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) were recorded throughout the session. RESULTS The study included 74 sessions of bilateral ECT with the modified ventilation protocol in 15 subjects. After VHV, the mean SpO2 increase was 2.12±2.14%, and the mean TcPCO2 decrease was 4.05±2.98 mmHg. TcPCO2 values at the moment of stimulus administration were 2.22±3.07 mmHg below pre-ECT values. The mean EEG seizure was 38.70±17.03 s, and postictal suppression was 68.31± 34.58% and 2.13±0.75 on a 0-3 scale. Brief desaturation (SpO2 <90) of 4-5 seconds duration was observed in 4 sessions. CONCLUSION This modified ventilation protocol was effective during COVID-19, and it did not elicit significant side effects. In addition to avoiding vigorous BMV, it induced moderate hypocapnia, which has been tied to seizure optimization and less hypercapnia during the apnea period.
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Affiliation(s)
- Aida de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
| | - Antònia Dalmau Llitjos
- Department of Anesthesiology, Reanimation and Pain Clinic, Bellvitge University Hospital-ICS, Universitat de Barcelona (UB), Barcelona, Spain
| | - Virginia Soria
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | - Javier Labad
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Spain
- Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Barcelona, Spain
| | - José Manuel Menchón
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | - Mikel Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
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Jiang W, Shi L, Zhao Q, Zhang W, Xu M, Wang W, Wang X, Bao H, Leng J, Jiang L. [Ultrasound assessment of gastric insufflation in obese patients receiving transnasal humidified rapid-insufflation ventilatory exchange during general anesthesia induction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1543-1549. [PMID: 33243741 DOI: 10.12122/j.issn.1673-4254.2020.11.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients. METHODS Ninety obese patients (BMI 30-39.9 kg/m2) undergoing laparoscopic cholecystectomy under general anesthesia were randomized into 3 groups (n=30) to receive facemask pre- oxygenation followed by face mask ventilation (FMV) after administration of anesthetics (Group M), oxygenation with THRIVE (Group T), or pre-oxygenation with facemask combined with THRIVE followed continuous oxygenation with both FMV and THRIVE after administration of anesthetics (Group M+T). The patients in the latter two groups received continuous oxygen via THRIVE during tracheal intubation. All the patients received real-time ultrasound monitoring of the gastric antrum, and positive gastric insufflation (GI+) was defined by the presence of comet-tail artifacts. The cross-sectional area of the gastic antrum (CSA-GA) was measured by ultrasound before and after pre-oxygenation and after intubation. The patients' SpO2, PaO2, and PaCO2 at admission (T1), 5 min after pre-oxygenation (T2), 5 min after medication (T3), and immediately after intubation (T4) were recorded, and the incidence of postoperative adverse events was assessed. RESULTS The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (P < 0.05). The CSA-GA was significantly greater at T4 than at T1 in Group M and Group M+T and in their GI+s ubgroups. The GI+ subgroups in Group M and Group M+ T had significantly larger CSA-GA at T4 than the GI- subgroups (P < 0.05). CSA-GA did not vary significantly during anesthesia induction in Group T (P>0.05). The incidence of grade Ⅰ gastric distension was lower but grade Ⅱ gastric distention was higher in Group M and Group M+T than in Group T (P < 0.05). Group M showed significantly greater variations of PaO2 at T3 and T4 than Group T and Group M+T (P < 0.05). CONCLUSIONS Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.
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Affiliation(s)
- Weiqing Jiang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Li Shi
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Qian Zhao
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Wenwen Zhang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Man Xu
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Wanling Wang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Xiaoliang Wang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Hongguang Bao
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Jing Leng
- Department of Pathology, Nanjing Medical University, Nanjing 210029, China
| | - Li Jiang
- The Royal Wolverhampton NHS Trust in UK, Wolverhampton, UK
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