Anesthesia progress最新文献

Objective: This study aimed to compare the incidence of postoperative nausea and vomiting (PONV) between propofol-based and remimazolam-based anesthesia in combination with dexamethasone and ondansetron.

Methods: Subjects were 20 to 50 years of age with a preoperative American Society of Anesthesiologists physical status classification I or II scheduled for bilateral sagittal split ramus osteotomy and genioplasty. General anesthesia was induced and maintained using propofol or remimazolam, and dexamethasone (6.6 mg) was administered after intubation. Ondansetron (4 mg) was administered intravenously 15 minutes before the end of surgery. Incidence of PONV was assessed overall and at 3 periods within the first 24 hours after anesthesia. Severity of PONV was assessed using a numerical rating scale (NRS), and quality of recovery was also assessed. Intravenous metoclopramide (10 mg) was administered for rescue in those with an NRS score greater than 4.

Results: A total of 100 subjects participated in this study and had an incidence of overall PONV that was higher with remimazolam (18%) than with propofol (6%) but lacked significance (P = .12). There were no significant differences in PONV at any of the periods, nor in mean NRS scores, quality of recovery, or metoclopramide use.

Conclusion: The incidence of PONV during 24 hours after orthognathic surgery was not significantly different when using remimazolam-based anesthesia vs propofol-based anesthesia in combination with dexamethasone and ondansetron. There were also no significant differences in the severity of PONV or the quality of recovery between the 2 groups.

Few reports exist in dentistry about the use of general anesthesia in children after liver transplant. In this paper, we report our experience utilizing general anesthesia for oral surgery in a 9-year-old girl who had undergone living donor liver transplantation. She was diagnosed with hepatoblastoma at 4 months of age and underwent a living donor liver transplant at 7 months of age. Due to a maxillary odontoma, impacted maxillary supernumerary teeth, and retained maxillary primary teeth, the patient was scheduled for general anesthesia. Preoperative blood tests revealed mild liver dysfunction, but no other abnormalities were noted. General anesthesia was administered with sevoflurane, rocuronium, fentanyl, and remifentanil, and no complications arose during the perioperative period. The patient was discharged without any significant issues the day after surgery. Precautions for the anesthetic management of children who have undergone living donor liver transplantation include assessing the patient for preoperative liver dysfunction and avoiding liver dysfunction caused by drugs used in conjunction with general anesthesia. Anesthetic agents and adjunctive medications should be carefully considered for use in patients with liver disease.

Objective: We aimed to investigate the differences in the lengths and shapes of several preformed nasotracheal tubes (NTTs) among different manufacturers and compare our findings with a previous report.

Methods: Using reference points at the tube tip, the proximal edge of the cuff, and the flexion point, we measured tube lengths for NTTs with inner diameters of 6.5, 7.0, and 7.5 mm from 4 manufacturers: the Parker Preformed Cuffed Endotracheal Tube (Parker), the Medtronic Taper Guard RAE (RAE), the Rusch AGT Nasal Preformed Cuffed Endotracheal Tube, and the Portex Polar Preformed Tracheal Tube. Cuff lengths and shapes were also assessed. A historical comparison was then performed using a previous report from 2012.

Results: The effective lengths (distance between tube tip and flexion point) were largest for the Parker tubes (295-315 mm). The RAE and Rusch tubes had the shortest effective lengths (270-290 mm). Cuff lengths ranged from 30 to 39 mm, and cuff shapes were cylindrical, tapered, and oval. Comparison with the past data revealed substantial changes in tube lengths for Parker and RAE tubes, modest increases in cuff lengths, and a change in cuff shape from oval to tapered in RAE tubes.

Conclusion: Several changes in tube lengths and cuff lengths/shapes were noted among manufacturers relative to the historical data. These findings demonstrate that manufacturer specifications can change over time. In dentistry and oral surgery, Parker tubes may be more ideal due to their longer effective lengths because extension and/or rotation of the neck can decrease NTT insertion depth.

Patients with seizure disorders frequently present for anesthetic care, and anesthesiologists must be adequately equipped to manage these patients safely throughout the perioperative period. While Part I of this review focused on seizure diagnosis, classification, and treatment, Part II focuses on perioperative considerations for patients with seizure disorders. A detailed preoperative assessment is imperative as well as an in-depth understanding of the patient's medications and treatment modalities. It is also important to understand how each perioperative medication affects the patient's seizure threshold. Finally, if a perioperative seizure does occur, prompt diagnosis and management is critical. This review aims to provide an overview of these topics for both hospital and office-based settings.

We report a rare case in which the inflation lumen at the tip of an endotracheal tube (ETT) was open, leading to intraoperative air leakage and cuff deflation. A patient with Down syndrome undergoing planned dental treatment under general anesthesia was induced and nasally intubated with a cuffed ETT that was then inflated with 5 mL of air. Soon thereafter, it was noted that the pilot balloon was deflated and filled with water droplets. The patient was successfully reintubated with a new, replacement ETT. Upon removal, we examined the defective ETT and sent it onward to the manufacturer. Upon further assessment, the manufacturer reported that the inflation lumen was not properly closed during the manufacturing process because of damage that went undetected. Anesthesia providers should assess an ETT for damage prior to use, including ensuring the cuff is functioning properly.

Remimazolam is an ultrashort-acting benzodiazepine approved for procedural sedation in 2020 by the US Food and Drug Administration; however, dosing information originating from the US is limited. No existing literature details infusion rates of remimazolam delivered by manually adjusted infusion pumps. This case report describes the administration of manually infused remimazolam to an 86-year-old man for the surgical extraction of third molars under procedural sedation. Following an initial dose of 4 mg delivered over 1 minute, the remimazolam infusion was titrated according to the patient's response from a starting rate of 15 mg/h to achieve deep sedation/general anesthesia. The maximum infusion rate was 30 mg/h, and a total dose of 14.1 mg of remimazolam was administered over 28 minutes. The surgery was successfully completed, the patient was satisfied with the anesthetic postoperatively, and he recovered and was discharged home without incident. Further studies are needed to fully characterize remimazolam infusions for a variety of patients using manually adjusted infusion pumps for use in the US.

Objective: There are very few studies on the use of a thermomechanical device for reducing injection pain in pediatric dentistry, especially for inferior alveolar nerve blocks (IANBs). The purpose of this study was to assess the efficacy of a thermomechanical device (Buzzy, Pain Care Labs) for reducing pain associated with an IANB for pediatric dental patients.

Methods: A total of 30 children, 5 to 8 years of age undergoing bilateral mandibular dental treatment requiring IANBs, were included in this randomized crossover study. The test group received an IANB with the use of the thermomechanical device and the control group received the IANB without the device. The groups were randomized, and the IANB was readministered after a 1-week washout interval. Subjective evaluation of pain was done utilizing the Wong-Baker Faces Pain Rating Scale, and objective evaluation of pain was assessed using the Faces, Leg, Activity, Consolability, Cry (FLACC) scale.

Results: Significant reductions in pain for the objective and subjective measures were noted in the thermomechanical device group (P ≤ .00016). No differences in pain ratings were noted in groups based on treatment sequence.

Conclusions: Less pain was observed when the thermomechanical device (Buzzy) was used during IANB injections vs without the device.