BMC Anesthesiology最新文献

Background: Tracheostomy is commonly performed to maintain airway patency or to provide prolonged ventilatory support in elective and emergency settings. Although it offers substantial benefits, tracheostomy may be associated with early and late complications. Fracture and migration of a tracheostomy tube is exceptionally rare, with an incidence of less than 1 in 1000 cases. Such events can lead to life-threatening airway obstruction and present significant anesthetic and airway management challenges during retrieval.

Case presentation: We report a 27-year-old male (weight 50 kg, height 172 cm, BMI 16.9 kg/m²) who had tracheostomy tube placed 18 years ago for prolonged ventilation after a road traffic accident. He had used the same metallic tube without replacement or follow-up. He presented with mild cough, blood-tinged sputum, and chest tightness. Imaging revealed a metallic foreign body in the right main bronchus. Emergency rigid bronchoscopy under general anesthesia allowed successful retrieval of the fractured outer tube through the tracheostomy stoma. Recovery was uneventful.

Conclusions: Fracture and migration of metallic tracheostomy tubes are rare but potentially life-threatening. Regular follow-up and timely tube replacement are vital for prevention. Effective management requires coordinated teamwork, careful anesthetic planning, and flexibility in ventilation strategies to ensure safety and good outcomes.

Background: Desflurane is a widely used inhalational anesthetic known for its advantageous properties in clinical settings. This study aimed to investigate the effects of desflurane inhalation on male reproductive hormones, testicular tissue integrity, and sperm morphology in a rat model.

Methods: Thirty male rats were allocated into six experimental groups: Control group (C): Administered 2 L/min of O₂ for 18 minutes daily over seven days. Group D1: Exposed to 1 minimum alveolar concentration (MAC) of desflurane and 2 L/min of O₂ for 18 minutes daily over seven days. Group D2: Received the same treatment as Group 1 for seven days, followed by a seven-day recovery period without intervention. Group D3: Administered 1 MAC desflurane and 2 L/min of O₂ for 18 minutes daily over 14 days. Group D4: Received the same treatment as Group 3 for 14 days, followed by a seven-day recovery period without intervention. Group D5: Administered the same treatment as Group 3 for 14 days, followed by a 14-day recovery period without intervention.Biochemical analyses were conducted to measure serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and inhibin B. Histopathological evaluations were performed to assess testicular tissue integrity, and sperm morphology was examined to identify abnormalities.

Results: Significant histopathological damage was observed in all experimental groups compared to the control group (p < 0.05). The proportion of morphologically abnormal spermatozoa was significantly higher in Groups D2, D3, D4, and D5 compared to the control group (p = 0.030, p = 0.002, p < 0.001, and p = 0.016, respectively). Compared to the control group, serum FSH levels showed a slight decrease across desflurane-exposed groups (ranging from -1.4% to +4.02%). The LH levels demonstrated a gradual reduction of approximately 0.32%-7.38%, while serum testosterone concentrations increased markedly, reaching up to 178% of the control level in the D4 group. Inhibin-B levels exhibited a progressive elevation of nearly 23-95% compared to control group.

Conclusion: Chronic inhalation of desflurane, a modern inhalational anesthetic, was found to adversely affect testicular histology, sperm morphology, and the regulation of male reproductive hormones in rats. These findings highlight potential reproductive toxicity associated with prolonged desflurane exposure.

Background: Intensive care unit-acquired weakness (ICU-AW) is a common complication among critically ill patients, including those with COVID-19. While viral myopathy and established ICU-related risk factors predispose patients with COVID-19 to muscle dysfunction, few studies have directly compared muscle wasting and weakness between ICU populations with and without COVID-19 using both structural and functional assessment modalities.

Methods: This was a small, non-concurrent, propensity score-matched ICU study which compared muscle wasting and strength in patients with and without COVID-19 who remained in the ICU for ≥ 7 days. Muscle thickness was assessed using ultrasound (US), body composition using bioelectrical impedance analysis (BIA), and functional strength using handgrip dynamometry. Measurements were performed on ICU days 1, 5, and 7. To reduce baseline differences, propensity score matching was applied using illness severity, nutritional risk, and mechanical ventilation parameters.

Results: In total, 143 patients were included (101 without COVID-19, 42 with COVID-19). After propensity score matching, 23 pairs were analysed. US revealed significant within-group reductions in muscle thickness over time in both matched cohorts, with no statistically significant between-group differences. BIA-derived phase angle (PhA) values were consistently lower in patients with COVID-19; however, between-group differences in PhA change lost statistical significance after matching. Handgrip dynamometry revealed a significantly higher incidence of muscle weakness in patients with COVID-19 initially, but this difference was non-significant. Absolute and residual strength remained similar between groups.

Conclusions: ICU patients both with and without COVID-19 experienced comparable degrees of muscle wasting and weakness when adjusted for baseline characteristics. ICU-AW appears more closely associated with the severity of critical illness and ICU treatments than with SARS-CoV-2 infection itself. US measurements appeared less affected by differences in fluid balance, whereas BIA-derived phase angle was more closely related to hydration status. Handgrip dynamometry provided a simple, objective measure of functional muscle strength at ICU discharge.