Anesthesia progress最新文献

Objective: Dilution of concentrated epinephrine prior to intravenous use during clinical emergencies can delay urgent interventions. The objective of this study was to determine whether diluted epinephrine remains stable and sterile over time in common hospital settings.

Methods: Epinephrine samples were prepared by clinically relevant double dilution techniques. Samples were stored in 10-mL syringes and incubated under 1 of 4 simulated hospital environments with a mixture of lighting and temperature settings: 4°C/20°C, with or without fluorescent lighting. Samples were incubated for 0, 15, 30, 60, or 90 days. Capillary zonal electrophoresis was used to quantify the concentration of epinephrine and/or presence of any degradation products. All samples were tested for the presence of bacterial growth using blood agar cultures.

Results: Diluted epinephrine samples remained stable for up to 90 days in all 4 simulated clinical storage conditions. No bacterial colony-forming units were detected in any of the environmental samples regardless of incubation duration, light, or temperature conditions.

Conclusion: Diluted epinephrine for anticipated clinical emergencies may remain clinically useful for up to 90 days, thus improving patient safety, access to medications, and overhead costs by reducing waste.

Most invasive dental procedures elicit some degree of bleeding which ultimately leads to clotting and eventual hemostasis. However, patients with inherited coagulation disorders may exhibit prolonged or, in some cases, excessive bleeding requiring multiple perioperative interventions. Von Willebrand disease is the most common inherited coagulopathy and often manifests via easy bruising, epistaxis, or prolonged bleeding. Hemophilia A (factor VII) and B (factor IX) are factor deficiencies that are clinically indistinguishable and managed according to severity and the required dental treatment. Other coagulopathies are rare (ie, inheritance is autosomal recessive) and may only become evident in homozygotes or compound heterozygotes. Current lab values and medical consultation with the patient's hematologist are imperative prior to rendering invasive dental treatment. There are a myriad of sedation and general anesthesia considerations, including risks for epistaxis with nasal instrumentation and bruising with improper patient positioning. Preoperative treatment with desmopressin or factor replacement may be required and generally should facilitate normal hemostasis. Additional therapies should be considered to help ensure adequate postoperative hemostasis, including pressure dressings, resorbable clotting materials, laser therapy, and oral rinses.

Muscle relaxants and their reverse drugs should be carefully administered to patients with acute polymyositis and/or dermatomyositis. However, the use of these drugs in controlled polymyositis and/or dermatomyositis is controversial. This case report describes the use of rocuronium and sugammadex in a 27-year-old female patient with controlled polymyositis who was scheduled for minor oral surgery under general anesthesia. General anesthesia was induced rapidly, and 0.66 mg/kg of rocuronium was administered prior to nasotracheal intubation. No additional muscle relaxants were administered during the surgery. At the end of surgery, approximately 2 hours after the rocuronium was administered, her train-of-four (TOF) ratio was still 49%. A dose of 3.3 mg/kg of sugammadex was administered, and it took 12 minutes for the TOF ratio to exceed 90%. The prolonged duration of muscle relaxation in patients with polymyositis may be due to a decrease in skeletal muscle and capillary volume. The slow onset of sugammadex may be caused by slow diffusion of rocuronium from the neuromuscular junction. Patients with polymyositis require close perioperative neuromuscular function monitoring, regardless of their disease control status.

We report a case in which tracheal stenosis was discovered during endotracheal intubation. A 19-year-old woman with Down syndrome was scheduled to undergo treatment of multiple dental caries under intubated general anesthesia. During the first general anesthetic, we felt some resistance while advancing the endotracheal tube through the trachea. Prior to a second general anesthetic 2 years later, we performed 3-dimensional computed tomography to evaluate the tracheal stenosis and devised a strategy that established an airway without advancing the endotracheal tube over the stenotic lesion. Careful attention is required when performing endotracheal intubation because patients with Down syndrome sometimes have tracheal stenosis.

Objective: This study aimed to establish which anesthetic agents are associated with minimized adverse outcomes during laryngeal mask airway (LMA) insertion.

Methods: Databases were searched for randomized controlled trials (RCTs) with American Society of Anesthesiologists I or II adult patients (≥15 years of age) receiving general anesthesia (GA) with an LMA. Propofol only was the comparator to other anesthetics used during LMA insertion. The primary outcome was prolonged apnea, and secondary outcomes were adverse airway events, LMA insertion failure, inadequate depth of anesthesia, and hemodynamic events. A network meta-analysis was conducted to estimate the treatment effects (odds ratios, 95% credible intervals, and surface under the cumulative ranking curve [SUCRA]).

Results: A total of 28 anesthetic combinations used on 4695 patients for GA induction and LMA insertion were examined across 53 RCTs. Overall, there was an apnea incidence rate of 33.3% (849 of 2548) with a mean time of 3.74 ± 3.56 minutes (n = 3091). Propofol + dexmedetomidine had the highest overall summed score of SUCRA ranks in reducing adverse outcomes (apnea incidence: SUCRA = 37%, apnea time: SUCRA = 66%, airway adverse event: SUCRA = 67%, insertion failure: SUCRA = 73%, inadequate depth of anesthesia: SUCRA = 84%). In comparison among all propofol combinations, propofol alone ranked lowest for overall summed score of SUCRA in reducing adverse outcomes (apnea incidence: SUCRA = 47%, apnea time: SUCRA = 71%, airway adverse event: SUCRA = 9%, insertion failure: SUCRA = 20%, inadequate depth of anesthesia: SUCRA = 9%).

Conclusion: All anesthetic combinations, other than those with thiopental, reduced adverse outcomes as compared with propofol alone. The combination of propofol and dexmedetomidine infused over 10 minutes ranked as the most effective for reducing adverse outcomes during LMA insertion.