BMC Anesthesiology最新文献

Background: This study aimed to evaluate the prediction of difficult intubation using ultrasonographic skin-to-vocal-cord measurements in obese Thai patients undergoing elective general anesthesia.

Methods: This prospective observational study was conducted from December 2020 to June 2023. Total 90 obese patients (body mass index ≥ 30 kg/m²) aged 18-60 years with an American Society of Anesthesiologists physical status classification of 2-3 requiring elective surgery under general anesthesia with oral endotracheal intubation in operating theatres were included. Anesthesiologists assessed the airway and measured the skin-to-vocal-cord distance using ultrasonography in the median coronal plane in the closed-mouth supine position. The primary outcome was difficult laryngoscopy, defined as a laryngoscopic view grade 3 or 4 on the Cormack-Lehane scale.

Results: The incidence of difficult laryngoscopy was 13.33% (12/90 patients). The median (interquartile range) body mass index in the difficult and easy intubation groups was 44.7 kg/m² (34.8-47.9) and 41.7 kg/m² (36.7-47.1), respectively (p = 0.929). The mean skin-to-vocal-cord distances (DSVC) in the difficult and easy intubation groups were 20.1 ± 7.2 mm and 16.3 ± 4.9 mm (p = 0.022), respectively. The median time for tracheal intubation in the difficult and easy intubation groups was 61.5 [50.2-120] s and 40 [30-56.8] s, respectively (p < 0.001). Multivariable logistic regression revealed that male sex and skin-to-vocal-cord distance ≥ 19.2 mm (area under the curve, 0.67) were significantly associated with difficult intubation. In sensitivity analysis excluding cases performed by anesthesiologists, DSVC ≥ 19.2 mm remained the only significant predictor of difficult intubation.

Conclusions: In obese Thai patients, A skin-to-vocal-cord distance of ≥ 19.2 mm measured by ultrasonography was associated with difficult laryngoscopy and remained consistent across sensitivity analyses. These factors may help predict difficult intubation. However, the modest diagnostic performance suggests that DSVC should not be used as a standalone predictor.

Trial registration: Thai Clinical Trials Registry (TCTR20250616007); registered on June 16, 2025.

Objective: The significant association between anesthetic sensitivity and postoperative outcomes in patients with valvular heart disease (VD) underscores the critical need for more reliable depth-of-anesthesia monitoring. This study sought to investigate propofol sensitivity and establish specific electroencephalography (EEG) biomarkers to guide safer anesthesia delivery in this high-risk population.

Methods: In this prospective observational trial, 40 patients (20 VD vs. 20 non-cardiac controls) received Schnider model-guided propofol target-controlled infusion. Primary outcome was effect-site propofol concentration at loss of consciousness (Ce^LOC). Prefrontal EEG dynamics (spectral power, bicoherence, burst suppression) were analyzed.

Results: VD patients exhibited 34% lower Ce^LOC versus controls (2.8 vs. 4.25 µg/mL; p = 0.0001). EEG revealed distinct neurosignatures: elevated β and θ power (β: 3.16 vs. 1.68, p = 0.0303; θ: 1.21 vs. 0.88, p = 0.0166), higher spectral power ratio (SPR: 1.38 vs. 1.98; p = 0.022), and intensified burst suppression (ratio: 0.11 vs. 0.32; p < 0.0001). Bicoherence analysis demonstrated impaired cross-frequency coupling in β and δ bands (β: 40.95 vs. 34.75, p = 0.0253; δ:43.5 vs. 30.95, p < 0.0001).

Conclusions: VD is associated with heightened propofol sensitivity and distinct EEG signatures, including patterns suggestive of thalamocortical dysrhythmia and cortical suppression. These findings suggest that disease-specific EEG monitoring may inform the development of precision anesthesia protocols for cardiac populations.

Background: Combined palsy of the hypoglossal and lingual nerves following laryngeal mask airway (LMA) use is a rare complication. This case report delineates the clinical course and management of this unique entity.

Case presentation: A 71-year-old male developed left-sided tongue paralysis and sensory loss in the anterior two-thirds of the tongue 24 hours after hand surgery under LMA anesthesia. Central lesions were excluded via neuroimaging. Electromyography (EMG) confirmed a left hypoglossal nerve conduction delay, consistent with neuropraxia. A multimodal treatment regimen comprising a 5-day course of intravenous methylprednisolone followed by a 2-week oral prednisone taper, murine nerve growth factor for two weeks, and targeted rehabilitation was implemented. Complete neurological recovery was achieved within three months, as confirmed by clinical assessment and normalized electrophysiological studies.

Conclusions: This case underscores that prolonged LMA use can lead to compound cranial neuropathy, likely due to mechanical compression at the tongue base. Early diagnosis, exclusion of central causes, and prompt initiation of combined anti-inflammatory, neurotrophic, and rehabilitative therapy are crucial for optimal recovery. Emphasis on individualized airway management and pressure monitoring in elderly patients is recommended to mitigate this risk.