Trends in Anaesthesia and Critical Care最新文献

英文中文

Nebulization of a combination of low dose dexmedetomidine and ketamine versus dexmedetomidine alone as a premedication for children undergoing cleft palate repair surgeries: A prospective randomized clinical trial 低剂量右美托咪定联合氯胺酮雾化与单独右美托咪定作为腭裂修复手术儿童前用药：一项前瞻性随机临床试验

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-30 DOI: 10.1016/j.tacc.2026.101639

Fatma Nabil , Samar A. Abdellah , Deiaaeldin M. Tamer , Mohamed El-Shazly , Mohamed Galal Aly , Hany M. Osman

Background

Sedation for young children who have cleft palate is challenging as poorly titrated sedation may result in respiratory depression, airway obstruction, or desaturation. The aim of this trial was to evaluate whether a nebulized combination of ketamine and low dose dexmedetomidine provides more effective preoperative sedation than dexmedetomidine alone in a higher dose for children undergoing cleft palate repair surgeries.

Methods

Fifty-six children, aged 1-4 years, who underwent cleft palate repair surgeries under general anesthesia were randomly assigned to receive preoperative sedation via nebulization either with a mixture of dexmedetomidine (1 µg/kg) and ketamine (2 mg/kg) in group DK (n = 28) or dexmedetomidine (2 µg/kg) alone in group D (n = 28). The primary outcome was the level of sedation after 30 minutes of completion of the nebulization. The secondary outcomes included assessment of parental separation, anesthesia mask acceptance, postoperative emergence delirium, postoperative pain, and any adverse events.

Results

The median (Q1-Q3) University of Michigan Sedation Scale score after 30 minutes of completion of the nebulization was 2 (1.3-2) in group DK versus 1 (1-2) in group D (P = 0.013). Furthermore, group DK showed more accepted parental separation anxiety scores and more satisfactory mask acceptance scores than group D (P = 0.005 and 0.018 respectively).

Conclusions

As a premedication for children undergoing cleft palate repair surgeries, a nebulized combination of ketamine and low dose dexmedetomidine appeared to be more effective than dexmedetomidine alone in a higher dose. This combination was also associated with better parental separation and acceptance of the anesthesia mask.

背景：对于腭裂患儿来说，镇静是一项挑战，因为滴定不良的镇静可能导致呼吸抑制、气道阻塞或去饱和。本试验的目的是评估氯胺酮和低剂量右美托咪定雾化组合是否比单独使用高剂量右美托咪定更有效地用于腭裂修复手术的儿童术前镇静。方法选择56例1 ~ 4岁全麻腭裂修补术患儿，随机分为DK组（n = 28）和D组（n = 28），分别采用右美托咪定（1µg/kg）和氯胺酮（2 mg/kg）混合雾化镇静。主要观察指标是完成雾化30分钟后的镇静水平。次要结局包括父母分离、麻醉面罩接受度、术后出现谵妄、术后疼痛和任何不良事件的评估。结果雾化完成30 min后，DK组的中位（Q1-Q3）密歇根大学镇静量表评分为2 (1.3-2)，D组为1(1-2)，差异有统计学意义（P = 0.013）。此外，DK组接受父母分离焦虑得分和面具接受得分均高于D组（P = 0.005和0.018）。结论氯胺酮联合小剂量右美托咪定雾化治疗腭裂修补术的疗效优于大剂量右美托咪定。这种组合也与更好的父母分离和麻醉面罩的接受有关。

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引用次数: 0

Toward a physiological approach to airway management in the critically ill: The utility of the ABCDE framework 迈向危重病人气道管理的生理途径：ABCDE框架的应用

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-14 DOI: 10.1016/j.tacc.2026.101631

R. Albillos-Almaraz , S. Balboa-Palomino , J. Fanjul-Cuesta

引用次数: 0

Density spectral array emergence pattern during TIVA: Neurophysiological and clinical implications 密度谱阵列出现模式在TIVA：神经生理和临床意义

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.tacc.2026.101633

Carolina Frederico Avendaño , Sarah Saxena , Joana Berger-Estilita

Emergence from anesthesia involves structured cortical transitions that are visible on the density spectral array (DSA). The “open crocodile upper jaw” pattern, defined by the separation of slow delta and re-emerging beta-gamma activity, has gained attention as a physiological marker and a teaching tool. Here, we contextualize this visual mnemonic phenomenon within established neurophysiology and emphasize its importance in understanding recovery from general anesthesia. This article provides new value by formally contextualizing an informal EEG teaching cue within established neurophysiology and translating it into a practical, clinically interpretable framework.

在密度谱阵列（DSA）上可以看到麻醉后出现的结构皮层转变。“张开的鳄鱼上颚”模式，由缓慢的三角洲和重新出现的β - γ活动的分离所定义，作为一种生理标志和教学工具而受到关注。在这里，我们将这种视觉助记现象置于已建立的神经生理学背景下，并强调其在理解全身麻醉恢复中的重要性。本文提供了新的价值，通过正式背景下的非正式脑电图教学线索在既定的神经生理学，并将其转化为一个实用的，临床可解释的框架。

引用次数: 0

Novel dual-port technique using fogarty balloon catheter for life-threatening rice silo aspiration: A case report 使用福格蒂球囊导管的新型双端口技术用于危及生命的水稻筒仓吸入：1例报告

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2025-12-31 DOI: 10.1016/j.tacc.2025.101621

Kanwaljit Singh , Eshaan Kaushik , Ankush Nayyar

Airway obstruction from foreign bodies in the aerodigestive tract is a common emergency, but massive aspiration of fine particulate matter can present unique challenges. Conventional tools such as rigid bronchoscopy or standard forceps may be insufficient in such cases. We report a rare case of a male patient who suffered massive rice particle aspiration, presenting with acute respiratory failure. The patient was successfully managed using a novel dual-port technique involving a Fogarty balloon catheter and a pediatric endotracheal tube during flexible bronchoscopy. This approach allowed effective foreign body extraction while minimizing airway trauma. This case highlights the potential of innovative, minimally invasive techniques in complex airway management and expands the applications of flexible bronchoscopy when standard interventions are inadequate.

气管消化道异物引起的气道阻塞是一种常见的紧急情况，但大量吸入细颗粒物可能会带来独特的挑战。在这种情况下，传统的工具如刚性支气管镜检查或标准钳可能是不够的。我们报告一个罕见的情况下，男性患者遭受大量大米颗粒吸入，呈现急性呼吸衰竭。在柔性支气管镜检查期间，患者成功地使用了一种新的双端口技术，包括福格蒂球囊导管和儿童气管内管。这种方法可以有效地取出异物，同时最大限度地减少气道创伤。本病例强调了创新的微创技术在复杂气道管理中的潜力，并在标准干预措施不足的情况下扩展了柔性支气管镜的应用。

引用次数: 0

A sudden “can't ventilate–can't intubate” crisis: The hidden pathology behind a silent airway 突然的“不能通气-不能插管”危机：无声气道背后隐藏的病理

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.tacc.2026.101635

Catarina Cruz Chaves, Francisca Santos

Unanticipated difficult airway remains a major cause of anaesthetic morbidity, often arising abruptly during seemingly routine inductions. Contemporary difficult airway frameworks emphasize early declaration of difficulty, minimization of repeated attempts, prioritisation of oxygenation, and restoration of spontaneous ventilation whenever feasible. We report the case of a 71-year-old man scheduled for urgent transurethral resection of a bladder tumour who developed a sudden “can't ventilate–can't intubate” (CVCI) event immediately after an apparently straightforward induction, despite the absence of major predictors of a difficult airway. Failure of both supraglottic airway ventilation and face-mask ventilation rapidly transformed a routine induction into a critical airway emergency, necessitating awakening of the patient to restore spontaneous ventilation. Subsequent ear, nose and throat assessment revealed a previously undiagnosed infiltrative supraglottic mass. Definitive airway management was later achieved under preserved spontaneous ventilation using videolaryngoscopy. This case illustrates a scenario uncomfortably familiar to experienced anaesthetists, in which a familiar clinical pathway suddenly diverges into a life-threatening airway crisis. It underscores the importance of early recognition of failed ventilation, consideration of occult laryngeal pathology in CVCI situations, and adherence to contemporary difficult airway principles.

意外的气道困难仍然是麻醉发病的主要原因，通常在看似常规的诱导过程中突然出现。当代气道困难框架强调早期发现困难，尽量减少重复尝试，优先供氧，并在可行的情况下恢复自然通气。我们报告了一例71岁的男性患者，他计划紧急经尿道膀胱肿瘤切除术，在明显的直接诱导后立即出现突然的“不能通气-不能插管”（CVCI）事件，尽管没有主要的气道困难预测因素。声门上气道通气和面罩通气均失败，迅速将常规诱导转变为严重的气道急诊，需要唤醒患者以恢复自发通气。随后的耳、鼻、喉检查显示先前未确诊的浸润性声门上肿块。最终气道管理是在保留的自发通气下通过视频喉镜实现的。这个病例说明了一个经验丰富的麻醉师所熟悉的令人不安的场景，在这个场景中，一个熟悉的临床途径突然分化成危及生命的气道危机。它强调了早期识别通气失败的重要性，在CVCI情况下考虑隐性喉病理，并坚持当代困难气道原则。

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引用次数: 0

Letter To The Editor Regarding “Comparative efficacy of ciprofol and propofol for sedation in patients undergoing colonoscopy: A systematic review, meta-analysis and trial sequential analysis of randomized controlled trials” 关于“环丙酚和异丙酚用于结肠镜检查患者镇静的比较疗效：随机对照试验的系统回顾、荟萃分析和试验序贯分析”的致编辑信

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-07 DOI: 10.1016/j.tacc.2026.101630

Saul Dominici , Italo C. Martins , Breno Dias L. Ribeiro , Victor Arthur Ohannesian , Brunno Braga Sauaia , Caio Márcio Barros de Oliveira , Plínio da Cunha Leal

引用次数: 0

Video-assisted fiberoptic intubation (VAFI) in patients undergoing general anesthesia for ENT surgery: Use of a videolaryngoscope with guide channel vs. without channel 视频辅助光纤插管（VAFI）在全麻耳鼻喉外科患者中的应用：带引导通道与无通道的视频喉镜的使用

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-02-12 DOI: 10.1016/j.tacc.2026.101641

Mariagrazia Cicala , Debora Felicetti , Leonardo Emberti-Gialloreti , Francesco Pugliese , Costantino Eugenio Buonopane

Purpose

Airway management is a critical aspect of anesthesia, as failed intubation is associated with severe morbidity. The combination of a videolaryngoscope (VL) with a flexible endoscope (FOB), known as video-assisted fiberoptic intubation (VAFI), improves glottic visualisation and endotracheal tube placement. However, evidence comparing VAFI performed with channeled versus non-channeled VLs is limited. This study aimed to compare the effectiveness of these two approaches in a controlled elective setting.

Methods

This prospective observational comparative study was conducted at Policlinico Umberto I University Hospital in Rome. Adult patients (ASA I–II) undergoing elective ENT surgery under general anesthesia were enrolled and allocated to two groups according to device availability: Group A (Airtraq channeled VL + FOB) and Group B (C-MAC D Blade non-channeled VL + FOB). The primary outcomes were total intubation time and first-attempt success. Secondary outcomes included intubation difficulty parameters.

Results

Thirty-seven patients were included (18 in Group A and 19 in Group B). Baseline characteristics were comparable between groups. Median total intubation time was 52 s in Group A and 44 s in Group B. First-attempt success was achieved in 78% and 79% of patients, respectively (p = 0.999). No statistically significant differences were observed in total intubation times or first-attempt success.

Conclusion

Within the limits of this prospective observational study, channeled or non-channeled videolaryngoscopes used as part of a VAFI strategy showed comparable intubation times and first-attempt success rates. When appropriate expertise and resources are available, device selection may reasonably be guided by operator familiarity and equipment availability.

目的气道管理是麻醉的一个关键方面，因为插管失败与严重的发病率相关。视频喉镜（VL）与柔性内窥镜（FOB）的结合，称为视频辅助光纤插管（VAFI），可改善声门显像和气管内插管的放置。然而，比较有通道和无通道VAFI的证据是有限的。本研究旨在比较这两种方法在控制选修设置的有效性。方法本前瞻性观察性比较研究在罗马Policlinico Umberto I大学医院进行。纳入在全麻下进行选择性耳鼻喉外科手术的成年患者（ASA I-II），并根据设备可用性分为两组：A组（Airtraq通道VL + FOB）和B组（C-MAC D Blade非通道VL + FOB）。主要观察指标为总插管时间和首次插管成功率。次要结局包括插管困难参数。结果共纳入37例患者，其中A组18例，B组19例。各组间基线特征具有可比性。A组插管总时间中位数为52 s， b组插管总时间中位数为44 s，首次成功率分别为78%和79% （p = 0.999）。总插管次数和首次插管成功率无统计学差异。结论：在这项前瞻性观察性研究的范围内，作为VAFI策略的一部分，使用通道或非通道视频喉镜的插管时间和首次尝试成功率相当。当有适当的专业知识和资源时，设备的选择可以合理地根据操作人员的熟悉程度和设备的可用性来指导。

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引用次数: 0

Navigating the swollen airway: Awake videolaryngoscopy as a rescue strategy after failed awake fibreoptic intubation in severe supraglottic edema – A case report 导航肿胀的气道：清醒视频喉镜作为严重声门上水肿清醒纤维插管失败后的抢救策略- 1例报告

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-17 DOI: 10.1016/j.tacc.2026.101634

Maria Carvalho , Gonçalo Pinto , Marta Afonso , Ana Belinha , Helena Barbosa , Ana Isabel Pereira

Acute supraglottic edema can rapidly progress to airway obstruction and awake fibreoptic intubation is often considered first-line approach. We report a case of life-threatening supraglottic swelling where awake fibreoptic intubation failed due to marked edema and airway reactivity. Awake videolaryngoscopy enabled successful tracheal intubation, securing the airway while preserving spontaneous ventilation. This case highlights the importance of flexibility in airway strategy selection, the value of videolaryngoscopy as a rescue technique and the essential role of multidisciplinary coordination in upper airway emergencies.

急性声门上水肿可迅速发展为气道阻塞，清醒纤维插管通常被认为是一线方法。我们报告一个危及生命的声门上肿胀的情况下，清醒纤维插管失败，由于明显的水肿和气道反应。清醒视频喉镜检查使气管插管成功，在保持自发通气的同时保护气道。本病例强调了气道策略选择灵活性的重要性，视频喉镜作为一种抢救技术的价值，以及多学科协调在上呼吸道紧急情况中的重要作用。

引用次数: 0

Face mask ventilation – to paralyze or not to paralyze, is that the question? 口罩通风——麻痹还是不麻痹，是这个问题吗？

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-22 DOI: 10.1016/j.tacc.2026.101637

Pavel Michalek , Manuel Á. Gómez-Ríos , Ana Isabel Pereira , Tomasz Gaszynski

引用次数: 0

Awake fibreoptic intubation in a rapidly deteriorating airway following blunt trauma to an advanced tongue carcinoma 晚期舌癌钝性创伤后迅速恶化气道的清醒纤维插管

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2026-04-01 Epub Date: 2026-01-17 DOI: 10.1016/j.tacc.2026.101632

J. Orankiewicz , B. Sadownik , P. Andruszkiewicz

引用次数: 0

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Trends in Anaesthesia and Critical Care

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