Trends in Anaesthesia and Critical Care最新文献_第7页

Narrative review of psilocybin, an important psychoactive substance with potential peri-anesthetic implications 裸盖菇素是一种重要的精神活性物质，具有潜在的麻醉作用

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101514

George L. Tewfik , Adejuyigbe Adaralegbe , Sangel Gomez , Rania Aziz , Faraz Chaudhry , Daniel Rodriguez-Correa , Dorisanne O. Adaralegbe

Psilocybin is a psychedelic substance with history of use for religious, medicinal and hallucinogenic purposes. The purpose of this review is to assess its past use, and its role both broadly in medicine and specifically in anesthesiology. Studies have shown benefits for chronic pain management, demonstrating utility in conditions including headaches and fibromyalgia, and psychiatric disturbances such as depression and anxiety. It has a high safety prof0ile, with a large disparity between a physiologic dose and that required to cause overdose symptoms. Its structure allows it to function as a serotonin receptor agonist, affecting the wiring of the brain and leading to possible anti-inflammatory effects. Perioperative management by anesthesia professionals should include a thorough pre-anesthetic exam to assess for usage and associated symptoms, as well as targeted testing. Intoxication requires supportive care, while overdose and withdrawal symptoms may require management of one's airway, circulation or appropriate medication. Patients should be monitored through the perioperative period, for psychologic symptoms that may necessitate modifications to the physical environment or pharmaceutical interventions. Rates of usage of psilocybin may increase if removed from Schedule I by the FDA based upon therapeutic uses for chronic pain and psychological disorders, amongst other conditions.

裸盖菇素是一种迷幻物质，历史上曾用于宗教、医药和致幻目的。本综述的目的是评估其过去的使用，以及其在医学和麻醉学中的广泛作用。研究表明，它对慢性疼痛管理有好处，对头痛和纤维肌痛以及抑郁和焦虑等精神障碍都有帮助。它具有很高的安全性，在生理剂量和引起过量症状所需的剂量之间存在很大差异。它的结构允许它作为血清素受体激动剂发挥作用，影响大脑的神经连接，并导致可能的抗炎作用。麻醉专业人员的围手术期管理应包括全面的麻醉前检查，以评估使用情况和相关症状，以及有针对性的检测。中毒需要支持性护理，而过量和戒断症状可能需要管理气道、循环或适当的药物治疗。患者应在围手术期监测可能需要改变物理环境或药物干预的心理症状。如果FDA将裸盖菇素从附表1中删除，基于慢性疼痛和心理障碍的治疗用途，以及其他情况，裸盖菇素的使用率可能会增加。

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引用次数: 0

Evaluating the lipsense device for reducing oral dryness in patients undergoing general anesthesia for elective daycare surgeries 评价唇感装置在全麻择期日托手术患者中减轻口腔干燥的作用

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101513

Alisha Goel, Vikas Saini, Rashi Sarna, Sameer Sethi, Summit Bloria, Waseem Ahmad Khan, Rajeev Chauhan

Background and aims

Postoperative thirst and oral dryness after general anesthesia is a well-known concern encountered in the post anesthesia care unit; equally distressing for the patient and the clinician. The Lipsense device (Coolsense ltd, Tel Aviv, Israel) is a novel device which allows controlled delivery of water to relieve thirst and oral dryness. We hypothesized lipsesne will be effective to decrease thirst and oral dryness and thus improve overall patient and care giver satisfaction.

Method

This was a prospective randomized controlled study conducted in 120 adult patients, equally divided into 3 groups receiving Lipsense, wet gauge and no intervention; undergoing daycare surgeries under general anesthesia and complaining of postoperative thirst. Numerical rating scores of thirst and oral dryness were measured at 0,1,2,3 h of postoperative period by an independent observer.

Results

The mean difference in intensity scores for thirst and oral dryness from baseline till the end of 3 h was greater in the Lipsense group (4.12 and 4.26 respectively) than in the wet gauge group (2.92 and 2.82). Lipsense resulted in a greater reduction, i.e. 72 % as compared to our hypothesis of 35 % reduction. Wet gauge resulted in a 46 % reduction in thirst intensity.

Conclusion

Lipsense is an effective device to reduce postoperative thirst and oral dryness with minimal side effects in comparison to wet gauge or no intervention in patients after general anesthesia.

背景与目的全身麻醉后的术后口渴和口腔干燥是麻醉后护理单位常见的问题；这对病人和医生来说都是痛苦的。Lipsense装置（Coolsense ltd, Tel Aviv, Israel）是一种新颖的装置，可以控制水的输送，缓解口渴和口腔干燥。我们假设，嘴唇将有效地减少口渴和口腔干燥，从而提高整体病人和护理人员的满意度。方法采用前瞻性随机对照研究，120例成年患者随机分为3组，分别给予Lipsense、wet gauge和不干预；在全麻下接受日托手术，术后抱怨口渴。由独立观察者于术后0、1、2、3小时测量口渴和口腔干燥的数值评分。结果从基线到3 h结束时，Lipsense组的口渴和口腔干燥强度评分的平均差异（分别为4.12和4.26）大于湿计组（分别为2.92和2.82）。Lipsense导致了更大的减少，即72%，而不是我们假设的35%的减少。湿测量导致口渴强度降低46%。结论lipsense是一种有效的减少患者术后口渴和口腔干燥的装置，与湿计相比，其副作用最小。

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引用次数: 0

Exploring the potential of artificial intelligence in airway management 探索人工智能在气道管理中的潜力

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101512

Luigi La Via , Antonino Maniaci , David Gage , Giuseppe Cuttone , Giovanni Misseri , Mario Lentini , Daniele Salvatore Paternò , Federico Pappalardo , Massimiliano Sorbello

This review examines the integration of Artificial Intelligence (AI) language models, particularly Chat GPT, in airway management. It explores AI's potential applications in education, clinical decision support, patient communication, and research, as well as its integration with existing medical technologies. The review highlights AI's benefits, including rapid access to current information, care standardization, and potential improvements in patient outcomes. However, it also addresses limitations and ethical considerations such as data security, algorithm bias, and the risk of over-reliance on AI systems. Looking forward, the review discusses AI's potential to revolutionize airway management through predictive analytics, augmented reality, and personalized learning platforms, while acknowledging implementation challenges. The broader implications of AI in healthcare are explored, including its impact on learning, innovation, and the balance between error-free decision-making and human creativity. The review concludes that while AI shows great promise in enhancing airway management, its implementation requires careful consideration of ethical implications and ongoing research. The future of AI in this field lies in its judicious use alongside skilled clinical judgment, potentially leading to significant improvements in patient care and outcomes.

本文综述了人工智能（AI）语言模型在气道管理中的集成，特别是Chat GPT。它探讨了人工智能在教育、临床决策支持、患者沟通和研究方面的潜在应用，以及与现有医疗技术的整合。该综述强调了人工智能的好处，包括快速获取当前信息、护理标准化和患者预后的潜在改善。然而，它也解决了数据安全、算法偏见和过度依赖人工智能系统的风险等限制和伦理问题。展望未来，该报告讨论了人工智能通过预测分析、增强现实和个性化学习平台彻底改变气道管理的潜力，同时承认了实施方面的挑战。探讨了人工智能在医疗保健领域的更广泛影响，包括其对学习、创新的影响，以及在无错误决策和人类创造力之间的平衡。该综述的结论是，虽然人工智能在加强气道管理方面显示出巨大的希望，但其实施需要仔细考虑伦理影响和正在进行的研究。人工智能在这一领域的未来在于它的明智使用和熟练的临床判断，可能会显著改善病人的护理和结果。

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引用次数: 0

Comparison of the hemodynamic responses to laryngoscopy and intubation on induction with etomidate, propofol-ketamine or propofol-etomidate: A randomized trial 比较依托咪酯、异丙酚-氯胺酮或异丙酚-依托咪酯诱导喉镜和插管的血流动力学反应：一项随机试验

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101504

Malvika Gupta, Anju R. Bhalotra, Shweta Dhiman, Rahil Singh

Background

Haemodynamic stability is desirable during induction of anaesthesia. Intravenous induction agents have differing haemodynamic effects. We compared the haemodynamic effects of combinations of propofol-ketamine (PK) and propofol-etomidate (PE) with etomidate alone during induction of anaesthesia and laryngoscopy and endotracheal intubation.

Material and methods

This randomized controlled study was conducted on 90 ASA I patients aged 18–50 years undergoing elective surgery requiring endotracheal intubation under general anaesthesia who were randomly allocated to either Group E (Etomidate 0.3 mg/kg), Group PE (Propofol 1 mg/kg + Etomidate 0.15 mg/kg) or Group PK (Propofol 1 mg/kg + Ketamine 1 mg/kg). Mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and bispectral index (BIS) values were compared at different time points.

Results

After anaesthesia induction, the percentage fall in mean, systolic and diastolic blood pressure was least in the PK group. Laryngoscopy and intubation led to a rise in haemodynamic parameters in all groups. The mean, systolic and diastolic blood pressures were significantly higher in Group E at 1 min after intubation as compared to the other two groups. With etomidate, the fall in MAP prior to intubation was greater as was the intubation response despite lower BIS values. No correlation was found between haemodynamic response and BIS values attained after intubation.

Conclusions

Combinations of propofol with ketamine and etomidate in the selected doses were found to be superior to etomidate alone with respect to haemodynamic stability. Co-induction with propofol and ketamine maybe preferred when haemodynamic stability is required. Ketamine has the advantage of providing potent analgesia in this dose.

背景：在麻醉诱导过程中，血流动力学稳定是理想的。静脉诱导剂有不同的血流动力学作用。我们比较了异丙酚-氯胺酮（PK）和异丙酚-依托咪酯（PE）与单独依托咪酯在麻醉、喉镜和气管插管诱导时的血流动力学影响。材料与方法本研究对90例年龄在18-50岁的ASA I期患者进行了随机对照研究，这些患者在全身麻醉下择期行气管插管手术，随机分为E组（依托咪酯0.3 mg/kg）、PE组（丙泊酚1 mg/kg +依托咪酯0.15 mg/kg）和PK组（丙泊酚1 mg/kg +氯胺酮1 mg/kg）。比较不同时间点的平均动脉压（MAP）、收缩压（SBP）、舒张压（DBP）、心率（HR）和双谱指数（BIS）值。结果麻醉诱导后，PK组平均血压、收缩压和舒张压下降百分比最小。喉镜检查和插管导致各组血流动力学参数升高。与其他两组相比，E组插管后1min的平均收缩压和舒张压明显升高。使用依托咪酯，插管前MAP下降更大，尽管BIS值较低，但插管反应也更大。插管后血流动力学反应与BIS值无相关性。结论异丙酚与氯胺酮和依托咪酯在一定剂量下联用在血液动力学稳定性方面优于单独使用依托咪酯。当需要血流动力学稳定性时，优选与异丙酚和氯胺酮共同诱导。氯胺酮在这种剂量下具有提供强效镇痛的优点。

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引用次数: 0

Validation of a novel handheld device for accurate cricoid pressure application on a laryngotracheal model 一种新颖的手持式设备的验证，用于准确的环软骨压力应用于喉气管模型

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101502

Connor T.A. Brenna , Sachin Doshi , Eric Plitman , Binu Jacob , Sarah Miles , Lisa Avery , Michael Esterlis , Rabail Chaudhry , Mandeep Singh , Michael Dinsmore

Background

Cricoid pressure, manual compression of the cricoid cartilage using 30 N of force, is a well-established technique to prevent regurgitation during airway management. However, applying and maintaining the correct force has proven difficult for providers. To address this, we developed a handheld Cricoid Pressure Device, which displays applied force in real time. This study aims to assess the device in terms of its ability to aid providers in applying the correct force.

Methods

In a single center study, twenty five healthcare providers performed cricoid pressure for three 60-s trials on a laryngotracheal model under three conditions: 1) Standard condition with no training, 2) Post-Training condition following syringe model training, and 3) Cricoid Pressure Device condition using our novel device. The primary outcome was the proportion of providers applying pressure within the target range (30 ± 5 N) for at least 95 % of the trial duration. Secondary outcomes included providers’ feedback on the usability of the device.

Results

Using the Cricoid Pressure Device, 92 % of providers applied force within the target range for the third trial, compared to 4 % in the Standard condition and 8 % in the Post-training condition. A logistic mixed effects model indicated that the odds of successful application using the Device were significantly higher than the Standard condition (OR = 482.7; 95 % CI 67.7, 3442.5). All participants believed the device would be extremely useful in clinical practice.

Conclusion

The Cricoid Pressure Device significantly improved provider's ability to apply the target cricoid pressure to a laryngotracheal model compared to standard practice.

环状软骨压力，即使用30牛的力对环状软骨进行手动压迫，是一种在气道管理过程中防止反流的成熟技术。然而，对于供应商来说，应用和保持正确的力是很困难的。为了解决这个问题，我们开发了一个手持式环状压力装置，它可以实时显示施加的力。本研究旨在评估该装置在帮助提供者施加正确力量方面的能力。方法在单中心研究中，25名医疗保健提供者在三种情况下对喉气管模型进行了3次60-s的环状压迫试验：1)未经训练的标准状态，2)注射器模型训练后的训练后状态，以及3)使用我们的新型装置的环状压迫装置状态。主要结果是在至少95%的试验时间内，在目标范围（30±5 N）内施加压力的提供者的比例。次要结果包括供应商对设备可用性的反馈。结果使用环状膜加压装置，92%的提供者在第三次试验中在目标范围内施力，而在标准条件下为4%，在训练后条件下为8%。逻辑混合效应模型表明，使用该设备成功应用的几率显著高于标准条件(OR = 482.7；95% ci 67.7, 3442.5)。所有参与者都认为该设备在临床实践中将非常有用。结论与标准做法相比，环状软骨加压装置显著提高了提供者对喉气管模型施加目标环状软骨压力的能力。

{"title":"Validation of a novel handheld device for accurate cricoid pressure application on a laryngotracheal model","authors":"Connor T.A. Brenna , Sachin Doshi , Eric Plitman , Binu Jacob , Sarah Miles , Lisa Avery , Michael Esterlis , Rabail Chaudhry , Mandeep Singh , Michael Dinsmore","doi":"10.1016/j.tacc.2024.101502","DOIUrl":"10.1016/j.tacc.2024.101502","url":null,"abstract":"<div><h3>Background</h3><div>Cricoid pressure, manual compression of the cricoid cartilage using 30 N of force, is a well-established technique to prevent regurgitation during airway management. However, applying and maintaining the correct force has proven difficult for providers. To address this, we developed a handheld Cricoid Pressure Device, which displays applied force in real time. This study aims to assess the device in terms of its ability to aid providers in applying the correct force.</div></div><div><h3>Methods</h3><div>In a single center study, twenty five healthcare providers performed cricoid pressure for three 60-s trials on a laryngotracheal model under three conditions: 1) Standard condition with no training, 2) Post-Training condition following syringe model training, and 3) Cricoid Pressure Device condition using our novel device. The primary outcome was the proportion of providers applying pressure within the target range (30 ± 5 N) for at least 95 % of the trial duration. Secondary outcomes included providers’ feedback on the usability of the device.</div></div><div><h3>Results</h3><div>Using the Cricoid Pressure Device, 92 % of providers applied force within the target range for the third trial, compared to 4 % in the Standard condition and 8 % in the Post-training condition. A logistic mixed effects model indicated that the odds of successful application using the Device were significantly higher than the Standard condition (OR = 482.7; 95 % CI 67.7, 3442.5). All participants believed the device would be extremely useful in clinical practice.</div></div><div><h3>Conclusion</h3><div>The Cricoid Pressure Device significantly improved provider's ability to apply the target cricoid pressure to a laryngotracheal model compared to standard practice.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"59 ","pages":"Article 101502"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143169306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does the combination of intravenous lidocaine and dexamethasone reduce the incidence of postoperative sore throat? A randomized controlled trial 静脉联合利多卡因和地塞米松是否能减少术后喉咙痛的发生率？随机对照试验

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101503

Mostafa Abdelkhalek, Esraa M. Elzeiny, Amgad A. Zaghlol, Emad El Hefnawy, Mohamed Y. Makharita

Background

The incidence of postoperative sore throat, cough, and hoarseness of voice remains significant, but the best method to reduce these symptoms is not yet definitive. The use of intravenous lidocaine combined with dexamethasone is a novel strategy to address these issues. This double-blind randomized controlled trial evaluated the incidence and severity of postoperative sore throat (POST) at rest and swallowing, cough, and hoarseness of voice by comparing the effects of a combination of intravenous lidocaine and dexamethasone versus intravenous dexamethasone alone.

Methods

One hundred forty patients, classified as American Society of Anesthesiologists physical status I or II, aged 18–60 years and scheduled for elective laparotomy requiring general anesthesia with endotracheal intubation for more than 120 min, were randomly assigned to receive either intravenous 8 mg dexamethasone (D group) or the same dose of dexamethasone combined with 1.5 mg/kg lidocaine (DL group). The incidence and severity of sore throat, cough, and hoarseness of voice were evaluated up to 24 h after surgery. The primary outcome measured was the incidence of POST at rest and swallowing.

Results

Data from 140 patients (70 patients in each group) was analyzed. The occurrence of a sore throat at rest was 41.4 % in group D and 21.4 % in group DL (P = .011). The incidence of postoperative sore throat (POST) when swallowing was 47.1 % for group D and 27.1 % for group DL (P = .014). Using dexamethasone combined with lidocaine reduced the severity of POST at rest and during swallowing at 1–2, 3, and 6 h after surgery. Multivariate logistic regression showed a reduction in POST incidence in the DL group (odds ratio, 0.4; 95 % confidence interval, 0.19–0.99; P = .05). There were no significant differences between the groups' incidence and severity of coughing or hoarseness.

Conclusions

Intravenous dexamethasone, combined with lidocaine, reduces the incidence and severity of postoperative sore throat at rest and during swallowing in patients requiring endotracheal intubation for over 120 min.

背景术后喉咙痛、咳嗽和声音嘶哑的发生率仍然很高，但减少这些症状的最佳方法尚未确定。静脉注射利多卡因联合地塞米松是解决这些问题的一种新策略。这项双盲随机对照试验通过比较静脉注射利多卡因和地塞米松与单独静脉注射地塞米松的效果，评估术后休息和吞咽时喉咙痛（POST）、咳嗽和声音嘶哑的发生率和严重程度。方法将140例年龄在18 ~ 60岁、美国麻醉学会评定为I级或II级的择期剖腹手术患者随机分为静脉注射地塞米松8mg （D组）和等量地塞米松联合利多卡因1.5 mg/kg （DL组）两组。术后24小时评估喉咙痛、咳嗽和声音嘶哑的发生率和严重程度。测量的主要结局是休息和吞咽时POST的发生率。结果分析140例患者资料，每组70例。静息时喉咙痛的发生率D组为41.4%，DL组为21.4% （P = 0.011）。术后吞咽时咽痛发生率D组为47.1%，DL组为27.1% （P = 0.014）。地塞米松联合利多卡因可降低术后1-2、3和6小时静息和吞咽时POST的严重程度。多因素logistic回归显示DL组POST发病率降低(优势比0.4；95%置信区间为0.19-0.99；p = 0.05)。两组患者咳嗽或声音嘶哑的发生率和严重程度无显著差异。结论静脉注射地塞米松联合利多卡因可降低术后静息及吞咽时咽痛的发生率和严重程度。

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引用次数: 0

Comparing the effectiveness of c-mac video laryngoscope™ and reverse sellick's techniques to the blind method for nasogastric tube insertion in anesthetized, intubated patients: A randomized controlled trial 比较c-mac视频喉镜™和反向sellick技术与盲法在麻醉插管患者中插入鼻胃管的有效性：一项随机对照试验

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101516

Nikhil Karthik B, Aparna Satish, Sushma H, Susmitha Vellanki, Mathew Tom, Malavika Kulkarni

Background

Nasogastric tube (NGT) insertion in the perioperative period is a common procedure undertaken by the anesthesiologist. The conventional technique of insertion is associated with a higher failure rate under anesthesia. Additional maneuvers and instrumentation are required for a successful insertion. In this study, we evaluated the effectiveness of the C-MAC ™ video laryngoscope system with the conventional and reverse Sellick's methods for the insertion of NGT.

Methods

In this prospective randomized controlled trial, participants aged 18–70 years who underwent elective surgeries requiring NGT insertion were randomized into three groups. The primary outcome was the first-attempt success rate. The secondary outcomes measured were the time taken for a successful first attempt, complication rate, and ease of insertion.

Results

120 patients were enrolled in the study. The C-MAC ™ group had a higher first-attempt success rate (95 %) compared to the reverse Sellicks group (77.5 %) and the conventional group (70 %) (P = 0.014). The time taken for a successful first attempt was highest in the C-MAC ™ group (C-MAC vs. reverse Sellick's vs. conventional; 34.71 ± 5.94 vs. 18.66 ± 7.42 vs. 21.06 ± 6.09; P < 0.001). The C-MAC ™ group reported the least complications and had the highest satisfaction rate compared to the three methods.

Conclusions

Employing a C-MAC video laryngoscope for insertion of NGT provides a higher success rate with the least number of complications compared to other techniques.

背景：围手术期鼻胃管（NGT）的插入是麻醉师进行的一项常见操作。传统的穿刺技术在麻醉下失败率较高。成功的插入需要额外的操作和仪器。在本研究中，我们评估了C-MAC™视频喉镜系统与传统和反向Sellick方法插入NGT的有效性。方法在这项前瞻性随机对照试验中，年龄在18-70岁的接受选择性手术需要植入NGT的参与者被随机分为三组。主要结果是第一次尝试的成功率。测量的次要结果是首次尝试成功所需的时间、并发症发生率和插入难易程度。结果120例患者入组。与反向Sellicks组（77.5%）和常规组（70%）相比，C-MAC™组的首次尝试成功率（95%）更高（P = 0.014）。首次尝试成功所需的时间在C-MAC™组最高(C-MAC vs.反向Sellick vs.常规；34.71±5.94 vs. 18.66±7.42 vs. 21.06±6.09；P & lt;0.001)。与三种方法相比，C-MAC™组并发症最少，满意度最高。结论采用C-MAC视频喉镜置入NGT的成功率高，并发症少。

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引用次数: 0

Intracuff alkalinized 2 % lignocaine versus air for endotracheal tube induced postoperative sore throat and other laryngotracheal morbidities- A randomized, controlled trial 鼻内碱化2%利多卡因与空气对照治疗气管插管术后喉咙痛和其他喉气管并发症-一项随机对照试验

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-12-01 DOI: 10.1016/j.tacc.2024.101500

Navdeep Kaur , Rashi Sarna , Indu Mohini Sen , Sandhya Yaddanapudi

Background

General anesthesia with endotracheal intubation can cause postoperative sore throat (POST). The utility of intracuff lignocaine for reduction of POST in children has not been widely reported. Current study aimed to assess incidence of POST in children by comparing the effect of 2 % alkalinized lignocaine or air filled in cuffed endotracheal tube (ETT).

Methodology

This prospective randomized controlled trial enrolled 64 ASAI,II children, 4–10 years planned for more than 1 h of elective surgery. After endotracheal intubation, the tube cuff was inflated with alkalinized 2 % lignocaine (Group L) or air(Group A). Post operative vitals and pain was noted at regular time intervals. Emergence delirium was assessed using Watcha score. Post-anesthesia recovery characteristics were assessed using Modified Aldrete Score. POST and other post-operative events like cough, thirst, hunger, vomiting were assessed for 24 h. SPSS version 22.0 was used for descriptive and inferential statistics. P value < 0.05 was considered statistically significant.

Results

Around 5(15.6 %) patients postoperatively,4(12.5 %) after waking up and2(6.2 %) at POD1 had sore throat in Group A while none had Group L. No significant difference was noted for post-operative sore throat, hoarseness, cough, vomiting, thirst and hunger at 1–2 h and POD1.

Conclusions

Inflating the ETT cuff with 2 % alkalinized lignocaine reduced the incidence of sore throat, hoarseness and emergence agitation. Further studies are required to validate the results.

背景：气管插管全麻可引起术后喉咙痛。注射利多卡因减少儿童POST的效用尚未被广泛报道。本研究旨在通过比较2%碱化的利多卡因或气管插管充气（ETT）的效果来评估儿童POST的发生率。方法：本前瞻性随机对照试验纳入64例ASAI II期儿童，4-10岁，计划择期手术1小时以上。气管插管后，用2%碱化的利多卡因（L组）或空气充气管袖（A组）。定期记录术后生命体征和疼痛。采用Watcha评分评估突发性谵妄。采用改良Aldrete评分评估麻醉后恢复特征。对术后24 h的POST及咳嗽、口渴、饥饿、呕吐等事件进行评估。采用SPSS 22.0版本进行描述性和推断性统计。P值<；0.05认为有统计学意义。结果A组患者术后5例（15.6%）、醒后4例（12.5%）、POD1时2例（6.2%）出现咽痛，而l组无患者出现咽痛、术后1 ~ 2 h嗓子哑、咳嗽、呕吐、口渴、饥饿与POD1比较差异无统计学意义。结论2%碱化利多卡因充气气管套可降低喉痛、声音嘶哑和出现性激动的发生率。需要进一步的研究来验证这些结果。

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引用次数: 0

Development of postoperative laryngeal edema in patients undergoing craniotomy for elective intracranial tumor excision: A prospective, observational, preliminary study 为选择性颅内肿瘤切除术而接受开颅手术的患者术后出现喉水肿的情况：一项前瞻性、观察性初步研究

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101496

Sivakumar R , Charu Mahajan , Niraj Kumar , Rajendra Singh Chouhan , Bijaya Laxmi

Background

Intracranial tumor surgeries require different head and surgical positions as well as large fluid administration, which can cause laryngeal edema (LE) and increased morbidity. But there are no studies regarding its incidence in this patient population. As these patients often receive steroids for reducing peri-tumoral edema, which can also reduce LE, we hypothesized that incidence of LE in patients undergoing intracranial tumor resection in various positions might not be high. Thus, this prospective, observational study aimed to find LE incidence, as assessed by cuff leak test (CLT) in these patients.

Methods

American Society of Anesthesiologists- Physical Status I/II, patients (18–60 yrs) undergoing elective intracranial tumor resection were included after atraumatic tracheal intubation under standard general anesthetic technique. Cuff leak volume (CLV) was measured in supine position before start of surgery (CLV_b) and completion (CLV_c) of surgery. CLV <110 ml was considered to indicate LE. Important parameters were noted and patients were followed till discharge from the hospital.

Results

Seventy-three patients with male preponderance (58.9 %) participated in study. Number of patients operated in supine, lateral, prone and sitting positions were 34, 16, 14 and 09, respectively. CLV decreased significantly in lateral and supine positions (p <0.01). Only, 02(2.74 %) patients had CLVc <110 ml; both were male patients operated in supine position with head rotation. Anesthetic duration and intraoperative fluid administration were comparable across surgical positions. No postextubation stridor was seen in any patient.

Conclusion

We found that optimal intraoperative care of patients undergoing excision of intracranial tumors resulted in a low postoperative LE incidence (2.74 %) as detected by CLT at completion of surgery. However larger studies are required to further elaborate this issue.

背景颅内肿瘤手术需要不同的头部和手术体位以及大量输液，这可能会导致喉头水肿（LE）并增加发病率。但目前还没有关于喉水肿在这类患者中发生率的研究。由于这些患者通常会接受类固醇治疗以减轻瘤周水肿，而类固醇也能减轻喉水肿，因此我们推测在接受各种体位的颅内肿瘤切除术的患者中，喉水肿的发生率可能并不高。这项前瞻性观察研究旨在通过袖带渗漏试验（CLT）评估这些患者的颅内肿瘤切除术的颅内肿瘤渗漏发生率。方法纳入美国麻醉医师协会体格状态 I/II 级、在标准全身麻醉技术下进行创伤性气管插管后接受择期颅内肿瘤切除术的患者（18-60 岁）。在手术开始前（CLVb）和手术完成后（CLVc），以仰卧位测量袖带漏气量（CLV）。CLV<110毫升被认为表示LE。研究人员记录了重要参数，并对患者进行了随访，直到他们出院。仰卧位、侧卧位、俯卧位和坐位手术的患者人数分别为 34 人、16 人、14 人和 09 人。CLV在侧卧位和仰卧位时明显下降（p <0.01）。只有 02 名（2.74 %）患者的 CLVc 为 110 毫升，这两名患者均为男性，在仰卧位并旋转头部的情况下进行手术。不同手术体位的麻醉时间和术中输液量相当。结论我们发现，对接受颅内肿瘤切除术的患者进行最佳术中护理可降低术后LE的发生率（2.74%），这是在手术完成时通过CLT检测到的。不过，还需要更大规模的研究来进一步阐述这一问题。

{"title":"Development of postoperative laryngeal edema in patients undergoing craniotomy for elective intracranial tumor excision: A prospective, observational, preliminary study","authors":"Sivakumar R , Charu Mahajan , Niraj Kumar , Rajendra Singh Chouhan , Bijaya Laxmi","doi":"10.1016/j.tacc.2024.101496","DOIUrl":"10.1016/j.tacc.2024.101496","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial tumor surgeries require different head and surgical positions as well as large fluid administration, which can cause laryngeal edema (LE) and increased morbidity. But there are no studies regarding its incidence in this patient population. As these patients often receive steroids for reducing peri-tumoral edema, which can also reduce LE, we hypothesized that incidence of LE in patients undergoing intracranial tumor resection in various positions might not be high. Thus, this prospective, observational study aimed to find LE incidence, as assessed by cuff leak test (CLT) in these patients.</div></div><div><h3>Methods</h3><div>American Society of Anesthesiologists- Physical Status I/II, patients (18–60 yrs) undergoing elective intracranial tumor resection were included after atraumatic tracheal intubation under standard general anesthetic technique. Cuff leak volume (CLV) was measured in supine position before start of surgery (CLV<sub>b</sub>) and completion (CLV<sub>c</sub>) of surgery. CLV <110 ml was considered to indicate LE. Important parameters were noted and patients were followed till discharge from the hospital.</div></div><div><h3>Results</h3><div>Seventy-three patients with male preponderance (58.9 %) participated in study. Number of patients operated in supine, lateral, prone and sitting positions were 34, 16, 14 and 09, respectively. CLV decreased significantly in lateral and supine positions (p <0.01). Only, 02(2.74 %) patients had CLVc <110 ml; both were male patients operated in supine position with head rotation. Anesthetic duration and intraoperative fluid administration were comparable across surgical positions. No postextubation stridor was seen in any patient.</div></div><div><h3>Conclusion</h3><div>We found that optimal intraoperative care of patients undergoing excision of intracranial tumors resulted in a low postoperative LE incidence (2.74 %) as detected by CLT at completion of surgery. However larger studies are required to further elaborate this issue.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101496"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges of scientific societies activities: Anesthesia and intensive care medicine. A scoping review 科学协会活动的挑战：麻醉与重症监护医学。范围审查

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101498

Luca Marino , Lucilla Scarpellini , Else-Marie Ringvold , Federico Bilotta

Scientific societies are historically established institutions. Historical duties and future challenges include: Improvement of patient and healthcare providers safety, enhancement of practice sustainability, boost of under-represented-minorities inclusion, promotion of innovation in technology and techniques.

This review is focused on evidence of tasks and roles of anesthesia and intensive care societies.

Google, Medline, Pubmed were utilized to find relevant studies.

The findings from the 39 included studies were categorized into the subsections: Established tasks, expanding roles, methodological hints to promote participation. The analysis of established task enhances the key role of scientific societies in education and research as foundations of high professionality skills. The expanding roles consider a large and heterogeneous list of topics: underrepresented minorities, patient and healthcare providers' safety, sustainability, technology innovation, ethical issues. The methodological hints to promote participation of effective strategies to endorse wider sharing.

Anesthesia and intensive care scientific societies have recognized functions that can be involved in the future expanding clinical and professional challenges. Both technical and non-technical skills are in the realm of the tasks of the scientific societies and the promotion of a broader participation will offer new opportunities for active collaborations.

科学学会是历史悠久的机构。其历史职责和未来挑战包括本综述重点关注麻醉和重症监护学会的任务和作用的证据，利用 Google、Medline 和 Pubmed 查找相关研究：纳入的 39 项研究结果被分为以下几个小部分：既定任务、扩展角色、促进参与的方法提示。对既定任务的分析加强了科学协会在教育和研究中作为高专业技能基础的关键作用。扩展角色考虑了大量不同的主题：代表性不足的少数群体、患者和医疗服务提供者的安全、可持续性、技术创新、伦理问题。麻醉和重症监护科学协会已经认识到可以参与应对未来不断扩大的临床和专业挑战的职能。技术和非技术技能都属于科学协会的任务范围，促进更广泛的参与将为积极合作提供新的机遇。

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引用次数: 0