Anesthesia progress最新文献

英文中文

Retrograde Intubation Over a Flexible Fiber-Optic Bronchoscope. 柔性纤维支气管镜逆行插管。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/anpr-68-04-01

Ramanjot S Kang, Robert Hutnik, Ishu Kant, A. Zlatopolsky, Chamandeep Brar, Slawomir P. Oleszak

Traditional retrograde intubation consists of tracheal intubation performed over a guide wire inserted into the trachea inferior to the vocal cords and then passed transorally or transnasally. This intubation technique is reserved for patients with a difficult airway when other methods such as blind nasal intubation or video laryngoscopy fail. A guide wire passed blindly in a retrograde fashion, however, is not without its own constraints. This case report presents the anesthetic management of a 23-year-old Duchenne muscular dystrophy patient with substantial scarring from a previous tracheostomy stoma and limited mouth opening. The patient underwent a retrograde fiber-optic transnasal intubation without the use of a guide wire for a tracheostomy revision procedure, followed by a second tracheostomy revision and retrograde fiber-optic transoral intubation 7.5 months later. This report demonstrates a novel technique for intubating patients with difficult airways. The use of a flexible fiber-optic bronchoscope for a retrograde intubation mitigates complications that can arise using traditional retrograde intubation over a guide wire and increases the likelihood of successful intubation.

传统的逆行插管包括在导丝上进行气管插管，导丝插入声带下方的气管，然后经口或经鼻插管。这种插管技术是为气道困难的患者保留的，当其他方法，如盲鼻插管或视频喉镜检查失败时。然而，以倒退的方式盲目通过的引导线也并非没有自身的限制。本病例报告介绍了一名23岁的Duchenne肌营养不良患者的麻醉处理，该患者之前的气管造口术留下了大量疤痕，开口受限。患者在不使用导丝的情况下接受了逆行光纤经鼻插管进行气管造口术翻修手术，随后在7.5个月后进行了第二次气管造口术和逆行光纤经口插管。这篇报告展示了一种为气道困难患者插管的新技术。使用柔性光纤支气管镜进行逆行插管可以缓解传统导丝逆行插管可能出现的并发症，并增加成功插管的可能性。

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引用次数: 0

Severe Bradycardia Occurring After Assisted Mouth Opening: A Case Report. 辅助张口后发生严重心动过缓1例报告。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/anpr-68-03-07

Yoshio Hayakawa, K. Fujii-Abe, T. Nakano, Masayuki Suzuki, H. Kawahara

We report a case of severe bradycardia during general anesthesia due to reduced atrioventricular conduction capacity believed to have been caused by the trigeminocardiac reflex (TCR). A 46-year-old woman was scheduled for intraoral scar revision under general anesthesia. When the surgeon opened her mouth intraoperatively, the patient's blood pressure immediately increased, and she developed significant bradycardia and a transient Mobitz type II second-degree atrioventricular block. It was assumed that the mandibular division of the trigeminal nerve (V-3) was stimulated by the surgeon stretching the patient's mouth open while remifentanil simultaneously provided sympatholytic effects, resulting in activation of the TCR. The patient quickly responded well to atropine and had no additional complications.

我们报告了一例全身麻醉期间因房室传导能力下降而出现严重心动过缓的病例，据信是由三叉神经反射（TCR）引起的。一位46岁的女性被安排在全身麻醉下进行口内瘢痕修复。当外科医生在手术中开口时，患者的血压立即升高，她出现了明显的心动过缓和短暂的Mobitz II型二度房室传导阻滞。假设外科医生张开患者的嘴刺激三叉神经（V-3）的下颌分裂，同时瑞芬太尼提供交感神经溶解作用，从而激活TCR。患者对阿托品反应迅速，没有其他并发症。

引用次数: 1

Perioperative Dental Injury Associated With Intubated General Anesthesia. 围手术期牙齿损伤与插管全麻。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/anpr-68-03-02

Taichi Kotani, Satoki Inoue, Masahiko Kawaguchi

Objective: Factors related to perioperative dental injury have likely changed as a variety of airway devices and preventive measures have been introduced. This retrospective chart review used data from an institutional registry to evaluate the incidence, timing, and contributing factors of patient self-reported dental injury and to assess the impact of dental injury on patient satisfaction.

Methods: Multivariate logistic analysis was performed on the records of 14,820 patients using the incidence of dental injury as the dependent variable and covariates in the anesthesia registry and a postoperative questionnaire as independent variables to investigate factors significantly associated perioperative dental injury. In addition, satisfaction with the anesthesia service was compared between patients with and without injury using a matched-pair population.

Results: A total of 101 dental injuries were identified. Of those, 25% were associated with intubation and extubation in the operating room, while most other injuries occurred postoperatively. Duration of anesthesia (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.03) and emergency surgery (OR, 1.92; 95% CI, 1.11-3.30) were independently associated with perioperative dental injury. Dental injury did not significantly decrease a patient's satisfaction with the anesthesia service (P = .441).

Conclusion: Most perioperative dental injuries are unrelated to anesthesia procedures. However, the duration of anesthesia and emergency surgery were significantly associated with perioperative dental injury, while decreased patient satisfaction was not.

目的随着各种气道设备和预防措施的引入，围手术期牙损伤的相关因素可能发生了变化。本回顾性图表回顾使用来自机构登记的数据来评估患者自述牙齿损伤的发生率、时间和影响因素，并评估牙齿损伤对患者满意度的影响。方法以牙损伤发生率为因变量和协变量，以术后问卷为自变量，对14820例患者围手术期牙损伤相关因素进行多因素logistic分析。此外，对麻醉服务的满意度比较患者之间有和没有使用配对人群受伤。结果共发现101例口腔损伤。其中，25%与手术室插管和拔管有关，而大多数其他损伤发生在术后。麻醉时间(优势比[OR]， 1.02;95%可信区间[CI]， 1.00-1.03)和急诊手术(OR, 1.92;95% CI, 1.11-3.30)与围手术期牙损伤独立相关。牙损伤并没有显著降低患者对麻醉服务的满意度(P = .441)。结论围手术期牙损伤与麻醉无关。然而，麻醉时间和急诊手术与围手术期牙损伤显著相关，而患者满意度的下降与围手术期牙损伤无关。

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引用次数: 0

Remimazolam: The Next Evolutionary Step for Sedative-Hypnotics. 雷马唑仑:镇静催眠药的下一个进化步骤。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/anpr-69-01-07

Kyle J. Kramer

引用次数: 1

Reversal Agents in Sedation and Anesthesia Practice for Dentistry. 牙科镇静和麻醉实践中的逆转剂。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/anpr-69-01-09

M. Wong

Reversal agents are defined as any drug used to counteract the pharmacologic effects of another drug. Several pharmacologic antagonists serve as essential drugs in the contemporary practices of sedation providers and anesthesiologists. Reversal or "antidote" drugs, such as flumazenil and naloxone, are often used in unintentional overdose situations involving significant benzodiazepine- and/or opioid-induced respiratory depression. Within the context of skeletal muscle relaxation, neostigmine and sugammadex are routinely used to reverse the effects of nondepolarizing neuromuscular blocking agents. In addition, the alpha-adrenergic antagonist phentolamine is used in dentistry as a local anesthetic reversal agent, decreasing its duration of action by inducing vasodilation. This review article discusses the pharmacology, uses, practical implications, adverse effects, and precautions needed for flumazenil, naloxone, neostigmine, sugammadex, and phentolamine within the context of sedation and anesthesia practice for dentistry.

逆转剂是指用于抵消另一种药物的药理学作用的任何药物。在镇静提供者和麻醉师的当代实践中，几种药物拮抗剂是必不可少的药物。逆转或“解药”药物，如氟马西尼和纳洛酮，通常用于涉及严重苯二氮卓类和/或阿片类药物引起的呼吸抑制的非故意过量情况。在骨骼肌放松的情况下，新斯的明和sugammadex通常用于逆转非极化神经肌肉阻滞剂的作用。此外，α-肾上腺素能拮抗剂酚妥拉明在牙科中被用作局部麻醉剂拮抗剂，通过诱导血管舒张来缩短其作用时间。这篇综述文章讨论了氟马西尼、纳洛酮、新斯的明、sugammadex和酚妥拉明在牙科镇静和麻醉实践中的药理学、用途、实际意义、不良反应和预防措施。

引用次数: 1

A Review of Current Literature of Interest to the Office-Based Anesthesiologist. 对办公室麻醉师感兴趣的当前文献综述。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/0003-3006-69.1.59

M. Saxen

does reduce inpatient opioid prescription knee arthroscopy. This study analyzed the impact of liposomal bupivacaine (regardless of administration route) on inpatient opioid use, resource utilization, and opioid-related complications among patients undergoing knee arthroplasty with a peripheral nerve block. A total of 88,830 surgeries from the Premier Healthcare Database were examined. Liposomal bupivacaine was used in 18,817 of these surgeries (21.2 % ). No association was found between the use of liposomal bupivacaine and clinically meaningful reduction in inpatient opioid use, opioid-related complications, or resource outcomes.

减少住院患者阿片类药物处方膝关节镜检查。本研究分析了布比卡因脂质体(不考虑给药途径)对行周围神经阻滞膝关节置换术患者阿片类药物使用、资源利用和阿片类药物相关并发症的影响。我们检查了来自Premier Healthcare数据库的总共88,830例手术。其中18817例(21.2%)手术使用脂质体布比卡因。未发现布比卡因脂质体的使用与住院阿片类药物使用、阿片类药物相关并发症或资源结局的临床意义减少之间存在关联。

引用次数: 0

Prospective Study on PDL Anesthesia as an Aide to Decrease Palatal Infiltration Pain. PDL麻醉辅助减轻腭部浸润性疼痛的前瞻性研究。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/anpr-68-03-03

B. Crump, A. Reader, J. Nusstein, Melissa Drum, Sara Fowler, J. Draper

OBJECTIVEThe purpose of this prospective randomized study was to assess using a periodontal ligament (PDL) injection as an aide to decrease palatal infiltration pain.METHODSA total of 133 subjects randomly received a PDL injection and alternative palatal infiltration or a mock PDL injection and conventional palatal infiltration at 2 separate appointments. PDL injection was given in the mid-palatal sulcus of the maxillary first molar. Mock PDL injection consisted of only needle insertion. All subjects then received a palatal infiltration administered into the blanched gingival tissue 3 mm (alternative palatal infiltration) or 7 mm (conventional palatal infiltration) from the gingival collar. Subjects recorded needle insertion and solution deposition pain using a Heft-Parker visual analog scale (VAS).RESULTSThe combined PDL injection and alternative palatal infiltration had significantly decreased mean VAS ratings for needle insertion and solution deposition pain (P < .0001). Incidence of moderate/severe pain for needle insertion and solution deposition was reduced from 65% to 1% and from 65% to 2%, respectively.CONCLUSIONProviding PDL anesthesia into the mid-palatal sulcus of the maxillary first molar and then administering an alternative palatal infiltration into the blanched collar around the PDL molar site led to significant reductions in needle insertion and solution deposition pain compared with a mock PDL and conventional palatal infiltration.

目的本前瞻性随机研究的目的是评估使用牙周膜（PDL）注射作为减轻腭部浸润疼痛的辅助药物。方法共有133名受试者在2个单独的预约中随机接受PDL注射和替代性腭部浸润，或模拟PDL注射并常规腭部浸润。PDL注射于上颌第一磨牙腭中沟。模拟PDL注射仅包括针头插入。然后，所有受试者接受腭部浸润，该腭部浸润施用到距牙龈环3mm（替代性腭部浸润）或7mm（常规腭部渗透）的漂白牙龈组织中。受试者使用Heft-Parker视觉模拟量表（VAS）记录针头插入和溶液沉积疼痛。结果PDL注射和替代性腭部浸润相结合显著降低了针头插入和溶解沉积疼痛的平均VAS评分（P<.0001）。针头插入和溶液沉积的中度/重度疼痛发生率从65%降至1%从65%到2%。结论在上颌第一磨牙的腭中沟内提供PDL麻醉，然后在PDL磨牙部位周围的漂白套环内进行替代性腭部浸润，与模拟PDL和传统腭部浸润相比，可显著减少针头插入和溶液沉积疼痛。

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引用次数: 0

Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia. 插管全麻加全静脉麻醉后口腔手术PONV危险因素的横断面研究。

Q3 Medicine

Anesthesia progress

Pub Date : 2022-04-01 DOI: 10.2344/anpr-68-03-12

Emi Ishikawa, Rie Iwamoto, Takayuki Hojo, Takahito Teshirogi, Keiji Hashimoto, M. Shibuya, Y. Kimura, T. Fujisawa

OBJECTIVEThe incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery.METHODSSubjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables.RESULTSAge (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours).CONCLUSIONThese findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.

目的据报道，全身静脉麻醉（TIVA）全麻后术后恶心呕吐（PONV）的发生率显著低于挥发性吸入剂（13.3%vs 25%）。然而，目前还没有关于与TIVA相关的PONV风险因素的研究报告。这项横断面回顾性研究旨在调查已知的风险因素是否影响在牙科或口腔颌面外科使用TIVA的插管全身麻醉剂中的PONV。方法761例患者在丙泊酚、芬太尼和瑞芬太尼的TIVA下接受了牙科或口腔颌面外科手术。使用PONV（24小时内）作为因变量，使用先前报告的风险因素作为自变量进行单变量和多变量逻辑回归分析。结果年龄（比值比[OR]：每年下降1.020；95%置信区间[CI]：1.0002-1.0418；P=.047）和女性（比值比：2.73；95%可信区间：1.60-4.84；P<.001）与PONV呈正相关。矢状支劈开截骨（SSRO）（OR:2.28；95%CI:1.21-433；P=.011）和双上颌截骨（OR:5.69；95%CI:2.09-15.99；P<.001）与PONV的相关性高于既不是双上颌截骨术也不是SSRO的手术。晚期PONV（2-24小时）的发病率是早期PONV的约2.7倍（0-2小时）。结论这些发现表明，除了丙泊酚的TIVA和预防性止吐剂用于正颌手术，特别是双上颌截骨外，还需要进一步的PONV对策。

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引用次数: 1

Prolonged Washout Period for Avoiding Azilsartan-Induced Refractory Hypotension During General Anesthesia for a Patient With Renal Impairment. 延长洗脱期避免阿齐沙坦致肾功能损害患者全麻期间难治性低血压。

Q3 Medicine

Anesthesia progress

Pub Date : 2021-12-01 DOI: 10.2344/anpr-68-02-08

Takayuki Hojo, Yukifumi Kimura, Keiji Hashimoto, Takahito Teshirogi, Toshiaki Fujisawa

Angiotensin receptor blockers (ARBs) are widely used to treat hypertension, but severe refractory hypotension during general anesthesia is a well-known complication associated with the continuation of ARBs during the perioperative period. It has therefore been recommended that ARBs be withheld for 24 hours before induction of general anesthesia. However, impaired renal function affects the pharmacokinetics of each ARB differently. The half-life of azilsartan is prolonged in accordance with the degree of renal impairment. Herein, we describe a patient with chronic kidney disease grade 3B who experienced severe refractory hypotension after induction of general anesthesia requiring administration of dopamine following inadequate responses to ephedrine and phenylephrine despite a 24-hour azilsartan washout period. When the same patient underwent general anesthesia for a subsequent surgery, azilsartan was withheld for 48 hours before induction, resulting in mild intraoperative hypotension that responded adequately to phenylephrine. Severe refractory hypotension during general anesthesia cannot always be avoided by holding azilsartan for 24 hours in patients with significant renal impairment. Therefore, a longer washout period may be preferable for patients regularly taking azilsartan who also have concurrent substantial renal impairment.

血管紧张素受体阻滞剂(ARBs)广泛用于治疗高血压，但全身麻醉期间严重难治性低血压是围手术期持续使用ARBs的常见并发症。因此，建议在全麻诱导前24小时不使用arb。然而，肾功能受损对每种ARB的药代动力学影响不同。阿兹沙坦的半衰期随肾脏损害程度而延长。在本文中，我们描述了一位3B级慢性肾病患者，他在诱导全身麻醉后出现了严重的难治性低血压，尽管阿齐沙坦有24小时的洗脱期，但由于麻黄碱和苯肾上腺素的反应不足，需要给予多巴胺。当同一患者在随后的手术中接受全身麻醉时，阿齐沙坦在诱导前48小时未使用，导致术中轻度低血压，对苯肾上腺素有充分反应。对于有明显肾功能损害的患者，阿齐沙坦维持24小时不能避免全麻时的严重难治性低血压。因此，对于定期服用阿兹沙坦同时存在严重肾功能损害的患者，较长的洗脱期可能是可取的。

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引用次数: 2

Effects of Local Anesthetics With Vasoconstrictors on Dental Pulp Blood Flow and Oxygen Tension. 血管收缩剂局部麻醉剂对牙髓血流和氧张力的影响。

Q3 Medicine

Anesthesia progress

Pub Date : 2021-12-01 DOI: 10.2344/anpr-68-02-09

Keikoku Tachibana, Masataka Kasahara, Nobuyuki Matsuura, Tatsuya Ichinohe

Objective: The aim of this study was to investigate the changes in pulpal blood flow (PBF) and pulpal oxygen tension (PpulpO2) after injecting local anesthetics with vasoconstrictors.

Methods: Under general anesthesia, male Japanese White rabbits were injected with 0.6 mL of 2% lidocaine with 1:80,000 epinephrine (LE) or 3% propitocaine (prilocaine) with 0.03 IU felypressin (PF) at the apical area of the lower incisor.

Results: Relative to baseline, PBF and PpulpO2 significantly decreased 5 minutes after LE or PF injection as compared with saline. The decrease in PBF was significantly lower in the LE group than in the PF group. Although the LE group had a larger decrease in PpulpO2 relative to baseline than the PF group did, that difference was not significant. PBF and PpulpO2 recovered to baseline faster in the PF group than in the LE group.

Conclusion: The injection of local anesthetic solutions containing vasoconstrictors (LE or PF) transiently caused significant decreases in PBF that resulted in significant decreases in PpulpO2. The recovery of PpulpO2 was faster than PBF regardless of the vasoconstrictor used.

目的:观察局部麻醉药加血管收缩剂后牙髓血流量(PBF)和牙髓氧张力(pulpo2)的变化。方法:在全身麻醉下，雄性日本大白兔下门牙尖区注射2%利多卡因加1:8万肾上腺素(LE) 0.6 mL或3%丙比卡因加0.03 IU felypressin (PF)。结果:与生理盐水相比，LE或PF注射后5分钟PBF和PpulpO2明显降低。LE组PBF的下降明显低于PF组。虽然与PF组相比，LE组的PpulpO2相对于基线有更大的下降，但这种差异并不显著。PF组PBF和PpulpO2恢复到基线的速度快于LE组。结论:局部麻醉溶液中含有血管收缩剂(LE或PF)可引起PBF的短暂性显著降低，从而导致PpulpO2的显著降低。无论使用何种血管收缩剂，PpulpO2的恢复速度都快于PBF。

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引用次数: 1

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