Minerva anestesiologica最新文献

Background: Head and neck extension achieves optimal surgical exposure during head and neck oncosurgeries. However, it can lead to cephalad migration of the tracheal tube, causing complications. Preventing shallow intubation is essential, especially in patients with difficult airway. Using an innovative technique, we aimed to measure the proximal migration of the nasotracheal tube at the vocal cords on neck extension in patients with difficult airway.

Methods: We enrolled 60 adult patients undergoing head and neck oncosurgeries with a mouth opening of less than 1.5 cm. After nasotracheal intubation using a flexible bronchoscope (FB), the FB was introduced into the adjacent nostril and maneuvered to reach the glottis. The FB was used to view and align the intubation depth mark (IDM) on the tracheal tube (TT) with the vocal cords in the neutral position. The outward migration of the TT at the vocal cords with a 30° to 40° neck extension was measured using the same maneuver. Also, the TT tip-to-carina distance was noted in both neutral and extension using FB.

Results: The mean proximal migration of the TT at the vocal cords during neck extension was 3±0.3 mm. The TT tip-to-carina distance increased by a mean of 20±7 mm with extension. The proximal migration contributed 15%, whereas elongation of the trachea contributed 85% to this increase.

Conclusions: The major contributing factor for the increase in TT tip-to-carina distance on neck extension was tracheal elongation rather than outward migration of the TT at vocal cords.

Background: Postoperative pulmonary complications (PPCs) are associated with high mortality and morbidity rates. Children are more susceptible to PPCs owing to smaller functional residual capacity and greater closing volume. Risk factors of PPCs in children undergoing lung resection remain unclear.

Methods: This retrospective study enrolled children who underwent video-assisted thoracoscopic surgery between January 2018 and February 2023. The primary outcome was PPC occurrence. Multivariate logistic regression was used to analyze risk factors for PPCs.

Results: Overall, 640 children were analyzed; their median age was 7 (interquartile range: 5-11) months, and the median tidal volume was 7.66 (6.59-8.49) mL/kg. One hundred and seventeen (18.3%) developed PPCs. PPCs were independently associated with male sex (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.17-2.88; P=0.008), longer OLV duration (OR, 1.01; 95% CI, 1.0-1.01; P=0.001), and less surgeon's experience (OR, 1.67; 95% CI, 1.03-2.7; P=0.036). When low-tidal-volume cutoff was defined as <8 mL/kg, PEEP level was a protective factor for PPCs (OR, 0.83; 95% CI, 0.69-1.00; P=0.046). Additionally, PPCs were associated with increased hospital stay (P<0.001).

Conclusions: Male sex, longer OLV duration, less surgeon's experience, and lower PEEP were risk factors of PPCs in children undergoing video-assisted thoracoscopic surgery. Our findings may serve as targets for prospective studies investigating specific ventilation strategies for children.

Introduction: Bougies and stylets are widely acknowledged as effective tools for managing endotracheal intubation, uncertainties persist regarding the comparative efficacy and safety of bougie versus stylet approaches in endotracheal intubation.

Evidence acquisition: A comprehensive electronic search was conducted on the Cochrane Library, PubMed, and Embase databases from inception to December 9, 2023, using the keywords "endotracheal intubation," "bougie," and "stylet." This meta-analysis aims to evaluate and compare the performance of bougies and stylets in patients undergoing endotracheal intubation.

Evidence synthesis: A total of 12 articles, encompassing 2534 participants, were included in this meta-analysis. The bougie approach did not exhibit superiority in first-attempt success rate (83.6% vs. 81.7%; OR, 1.06, 95% CI, 0.49 to 2.29; P=0.89) and total intubation success rate (99.3% vs. 97.6%; OR, 2.32, 95% CI, 0.44 to 12.34; P=0.32, I²>50%, P<0.001). However, in patients with difficult airways, the bougie approach demonstrated a superior first-attempt success rate compared to the stylet approach (93.8% vs. 76.4%; OR, 5.25, 95% CI, 2.74 to 10.05; P<0.001). There was no significant difference in complications between the bougie and stylet approaches (P>0.05).

Conclusions: For patients with difficult airway characteristics, our recommendation is to perform endotracheal intubation (ETI) using the bougie approach over the stylet approach, as it has been associated with a better first-attempt success rate. Notably, the advantages of using a bougie may be less pronounced for patients without signs of a difficult airway.