Anesthesia progress最新文献

Nasal intubation is often required during oral surgery; however, nasal intubation can cause various complications including bleeding associated with nasal mucosal trauma during intubation and obstruction of the endotracheal tube. Two days before surgery, a nasal septal perforation was identified using computed tomography during a preoperative otorhinolaryngology consultation for a patient planned to undergo a nasally intubated general anesthetic. Subsequently, nasotracheal intubation was successfully performed after confirming the size and location of the nasal septal perforation. We used a flexible fiber optic bronchoscope to safely perform the nasal intubation while assessing for inadvertent migration of the endotracheal tube or soft-tissue damage around the perforation site. Careful preoperative planning in cooperation with the otorhinolaryngology department and use of computed tomography is recommended when a nasal abnormality is suspected.

Objective: Opioid-induced hyperalgesia, a paradoxical increase in pain sensitivity associated with ongoing opioid use, may worsen the postoperative pain experience. This pilot study examined the effect of chronic opioid use on pain responses in patients undergoing a standardized dental surgery.

Methods: Experimental and subjective pain responses were compared prior to and immediately following planned multiple tooth extractions between patients with chronic pain on opioid therapy (≥30 mg morphine equivalents/d) and opioid-naïve patients without chronic pain matched on sex, race, age, and degree of surgical trauma.

Results: Preoperatively, chronic opioid users rated experimental pain as more severe and appreciated less central modulation of that pain than did opioid-naïve participants. Postoperatively, chronic opioid-using patients rated their pain as more severe during the first 48 hours and used almost twice as many postoperative analgesic doses during the first 72 hours as the opioid-naïve controls.

Conclusion: These data suggest that patients with chronic pain taking opioids approach surgical interventions with heightened pain sensitivity and have a more severe postoperative pain experience, providing evidence that their complaints of postoperative pain should be taken seriously and managed appropriately.

The use of video laryngoscopy is growing in patients with anatomical factors suggestive of a difficult airway. This case report describes the successful tracheal intubation of a 54-year-old female patient with limited mouth opening scheduled for third molar extraction under general anesthesia. The Airway scope (AWS) along with a gum-elastic bougie was used to secure the airway after failed direct laryngoscopy and video laryngoscopy using the McGrath MAC with an X-blade. The AWS has a J-shaped structure in which the blade approximates the curvature of the pharynx and larynx. This blade shape makes it easy to match the laryngeal axis with the visual field direction, enabling successful tracheal intubation even for patients with limited mouth opening. A major key to successful video laryngoscopy is to select a video laryngoscope based on the anatomical characteristics of patients with a difficult airway.

Part 1 of "Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery" covered the physiological process of hemostasis and the pharmacology of both traditional and novel oral antiplatelets and anticoagulants. Part 2 of this review discusses various factors that are considered when developing a perioperative management plan for patients on oral antithrombotic therapy in consultation with dental professionals and managing physicians. Additionally included are how thrombotic and thromboembolic risks are assessed as well as how patient- and procedure-specific bleeding risks are evaluated. Special attention is given to the bleeding risks associated with procedures encountered when providing sedation and general anesthesia within the office-based dental environment.

Objective: The risk of a spontaneous surgical fire increases as oxygen concentrations surrounding the surgical site rise above the normal atmospheric level of 21%. Previously published in vitro findings imply this phenomenon (termed oxygen pooling) occurs during dental procedures under sedation and general anesthesia; however, it has not been clinically documented.

Methods: Thirty-one children classified as American Society of Anesthesiologists I and II between 2 and 6 years of age undergoing office-based general anesthesia for complete dental rehabilitation were monitored for intraoral ambient oxygen concentration, end-tidal CO2, and respiratory rate changes immediately following nasotracheal intubation or insertion of nasopharyngeal airways, followed by high-speed suctioning of the oral cavity during simulated dental treatment.

Results: Mean ambient intraoral oxygen concentrations ranging from 46.9% to 72.1%, levels consistent with oxygen pooling, occurred in the nasopharyngeal airway group prior to the introduction of high-speed oral suctioning. However, 1 minute of suctioning reversed the oxygen pooling to 31.2%. Oropharyngeal ambient oxygen concentrations in patients with uncuffed endotracheal tubes ranged from 24.1% to 26.6% prior to high-speed suctioning, which reversed the pooling to 21.1% after 1 minute.

Conclusion: This study demonstrated significant oxygen pooling with nasopharyngeal airway use before and after high-speed suctioning. Uncuffed endotracheal intubation showed minimal pooling, which was reversed to room air ambient oxygen concentrations after 1 minute of suctioning.