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Hypoxemia during anesthesia

Mohamed Ghalayini, Pierre-Yves Brun, Pascal Augustin, Elise Guivarch, Marie Pierre Dilly, Sophie Provenchere, Pierre Mordant, Yves Castier, Philippe Montravers, Dan Longrois
Competitive flows syndrome result in severe regional hypoxemia when the deoxygenated flow from the native left ventricle (LV) competes with oxygenated flow from extracorporeal life support (ECLS) pump with potentially severe consequences for the cerebral and coronary circulations. Fast correction of hypoxemia could be obtained by decreasing native LV flow by infusion of a short-acting beta-blocker (esmolol). Our purpose was to retrospectively review the efficacy of esmolol in this situation and hypothesize on the potential mechanisms of action and the associated risks...
September 2016: Journal of Extra-corporeal Technology
Nitish Fokeerah, Xinwei Liu, Yonggang Hao, Lihua Peng
Managing a patient scheduled for bronchoesophageal fistula repair is challenging for the anesthetist. If appropriate ventilation strategy is not employed, serious complications such as hypoxemia, gastric distension, and pulmonary aspiration can occur. We present the case of a 62-year-old man with a bronchoesophageal fistula in the left main stem bronchus requiring the insertion of a Y-shaped tracheobronchial stent through a rigid bronchoscope, under general anesthesia. We successfully managed this intervention and herein report this case to demonstrate the effectiveness of underwater seal gastrostomy tube drainage used in conjunction with high-frequency jet ventilation during bronchoesophageal fistula stenting...
2016: Case Reports in Anesthesiology
Audrey Monastesse, Francois Girard, Nathalie Massicotte, Carl Chartrand-Lefebvre, Martin Girard
BACKGROUND: Few diagnostic tools are available to anesthesiologists when confronted with intraoperative hypoxemia. Lung ultrasonography is a safe and accurate bedside imaging modality. The aim of this study was to evaluate the feasibility of lung ultrasonography during the perioperative period and assess its ability to detect intraoperative respiratory complications and oxygenation changes resulting from perioperative atelectasis. METHODS: In this prospective observational pilot study, 30 consecutive patients scheduled for laparoscopic surgery were recruited...
September 23, 2016: Anesthesia and Analgesia
Jinhua Zhang, Yong Huang, Zhao Li, Jian Li, Kunpeng Liu, Chenghui Li
PURPOSE: To compare the efficacy and remifentanil with midazolam for conscious sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS: 99 patients scheduled for ERCP were randomly allocated to be treated with either meperidine/midazolam (group C, n = 33), remifentanil (group R, n = 33), or the remifentanil plus midazolam (group RM, n = 33). In group C, intermittent intravenous meperidine and midazolam were administrated during the procedure; in group R, remifentanil was infused continuously at a rate of 0...
November 2016: International Journal of Clinical Pharmacology and Therapeutics
Matthias Görges, Nicholas C West, Edda Karlsdóttir, J Mark Ansermino, Myles Cassidy, Gillian R Lauder
BACKGROUND: Commonly used general anesthetics are considered to be neurotoxic to the developing rodent brain, leading to poor long-term outcome. However, it is unclear whether these rodent studies can be extrapolated to the human neonate. Given that anesthesia for urgent neonatal surgery cannot be avoided, it is vitally important to assess other factors that may impact neurological outcome following anesthesia and surgery. OBJECTIVE: The purpose of this study is to identify thresholds for detecting vital sign deviations, which may have the potential for affecting neurological outcome following anesthesia and surgery in neonates...
November 2016: Paediatric Anaesthesia
Kazutomo Saito, Hiroaki Toyama, Yutaka Ejima, Masanori Yamauchi
In Eisenmenger syndrome (ES), positive pressure ventilation (PPV) during general anesthesia may lead to an increase in pulmonary vascular resistance and potentially to hypoxemia. In an attempt to predict the patient's hemodynamic response to intraoperative ventilation, we tested preoperatively the hemodynamic effects of noninvasive PPV with continuous positive pressure in a woman with ES scheduled for oophorectomy. The surgery was performed without complications, and the patient was discharged on postoperative day 8...
August 22, 2016: A & A Case Reports
Yiorgos Alexandros Cavayas, Martin Girard, Georges Desjardins, André Y Denault
BACKGROUND: Acute deterioration in respiratory status commonly occurs in patients who cannot be transported for imaging studies, particularly during surgical procedures and in critical care settings. Transthoracic lung ultrasonography has been developed to allow rapid diagnosis of respiratory conditions at the bedside. Nevertheless, the thorax is not always accessible, especially in the perioperative setting. Transesophageal lung ultrasonography (TELU) can be used to circumvent this problem...
November 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
George W Williams, Christy A George, Brian C Harvey, Jenny E Freeman
BACKGROUND: Current respiratory monitoring technologies such as pulse oximetry and capnography have been insufficient to identify early signs of respiratory compromise in nonintubated patients. Pulse oximetry, when used appropriately, will alert the caregiver to an episode of dangerous hypoxemia. However, desaturation lags significantly behind hypoventilation and alarm fatigue due to false alarms poses an additional problem. Capnography, which measures end-tidal CO2 (EtCO2) and respiratory rate (RR), has not been universally used for nonintubated patients for multiple reasons, including the inability to reliably relate EtCO2 to the level of impending respiratory compromise and lack of patient compliance...
July 5, 2016: Anesthesia and Analgesia
Guillaume Besch, Angeline Chopard-Guillemin, Elisabeth Monnet, Arnaud Causeret, Amelie Jurine, Gerald Baudry, Benjamin Lasry, Laurent Tavernier, Emmanuel Samain, Sebastien Pili-Floury
BACKGROUND: The ENDOTANIL trial aimed at comparing an association of target-controlled infusion (TCI) of remifentanil and propofol to TCI of propofol alone on the clinical conditions during pan endoscopy for assessment of the upper airway (pan endoscopy) performed under tubeless general anesthesia. METHODS: This double-blind, single center, parallel, randomized, placebo-controlled trial was conducted in a French tertiary level of care, from June 2009 to February 2013...
June 17, 2016: Minerva Anestesiologica
Michael R King, T Anthony Anderson, Jinghu Sui, Guoluo He, Kwun Yee T Poon, Charles J Coté
STUDY OBJECTIVE: To assess the effects of desaturation on stroke index (SI), cardiac index (CI), and heart rate (HR) using the ICON continuous noninvasive cardiac output monitor in children undergoing general anesthesia. DESIGN: Retrospective analysis of a prospectively collected data set. SETTING: Pediatric operating rooms in a tertiary academic medical center. PATIENTS: Children younger than 20 years who experienced desaturation while undergoing general anesthesia...
August 2016: Journal of Clinical Anesthesia
Ayman Ads, Frederic Auerbach, Kelly Ryan, Abdel R El-Ganzouri
We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report...
August 2016: Journal of Clinical Anesthesia
Jing-Yang Liou, Chien-Kun Ting, Ming-Chih Hou, Mei-Yung Tsou
Classical midazolam-opioid combination for gastrointestinal endoscopy sedation has been adopted for decades. Dosing regimens have been studied but most require fixed dosing intervals. We intend to use a sophisticated pharmacodynamic tool, response surface model (RSM), to simulate sedation using different regimens. RSM can predict patient's response during different phases of the examination and predict patient's wake-up time with precision and without the need for fixed dosing intervals. We believe it will aid physicians in guiding their dosing strategy and timing...
June 2016: Medicine (Baltimore)
Marcel Simon, Christian Wachs, Stephan Braune, Geraldine de Heer, Daniel Frings, Stefan Kluge
BACKGROUND: Critically ill patients with respiratory failure undergoing intubation have an increased risk of hypoxemia-related complications. Delivering oxygen via a high-flow nasal cannula (HFNC) has theoretical advantages and is increasingly used. This study was conducted to compare HFNC with bag-valve-mask (BVM) for preoxygenation and to assess oxygenation during intubation in subjects with hypoxemic respiratory failure. METHODS: This study was a randomized controlled trial including 40 critically ill subjects with hypoxemic respiratory failure who received either HFNC or BVM for preoxygenation before intubation in the ICU...
September 2016: Respiratory Care
Priyanka Gokhale, Justin R Lappen, Jonathan H Waters, Lisa K Perriera
BACKGROUND: The primary objective of this study was to assess the risk of perioperative anesthesia-related complications in a cohort of obese and non-obese women undergoing outpatient surgical abortion under IV sedation without tracheal intubation. METHODS: We performed a retrospective cohort study of all surgical abortions through 22 6/7 weeks' gestation at an outpatient clinic from 2012 to 2013. Women receiving IV sedation were included. Obesity status was defined by the World Health Organization criteria...
June 2016: Anesthesia and Analgesia
T Kammerer, E Speck, V von Dossow
Thoracic surgery represents a special challenge for anesthesia and requires a high level of human and material resources. Accurate knowledge of the pathophysiology is essential for selection of the anesthetic procedure, the separation of the lungs, monitoring and treatment of hemodynamics as well as for postoperative follow-up care. The increasing number of thoracic interventions and patients who are often suffering from complex diseases require close interdisciplinary cooperation between surgeons, anesthesiologists and intensive care specialists...
May 2016: Der Anaesthesist
Ho-Jin Lee, Jung-Man Lee, Chul-Woo Jung, Jiwon Lee
For patients with HPS who require anesthesia for a procedure, HPV should be maintained to prevent worsening hypoxemia. Here, the case of a 9-yr-old girl who was scheduled for a living donor liver transplantation is presented. The patient suffered from end-stage liver disease with HPS due to biliary atresia, which contributed to the development of a diffuse pulmonary AVF. Consequently, anesthetic management of this patient involved two different types of pulmonary shunt. It is important to maintain HPV, not only to prevent worsening of the hypoxia caused by HPS but also to inhibit an increase in PVR that could cause an increase of shunt flow through the pathological fistula...
August 2016: Pediatric Transplantation
Arnaud Potié, Caroline Prégardien, Thierry Pirotte, Xavier Stephenne, Isabelle Scheers, Catherine Wanty, Françoise Smets, Etienne Sokal, Francis Veyckemans
AIMS: The aim of this study was to evaluate the usability and safety of the Explorer Endoscopy Mask(®) (EM) as an alternative to endotracheal intubation in children undergoing elective esogastroduodenoscopy (EGD) under general anesthesia (GA). METHODS: This study was a retrospective observational study. The study was undertaken at the pediatric digestive endoscopy suite in the Cliniques universitaires Saint-Luc, Brussels, Belgium. We retrospectively analyzed the occurrence of minor and major airway-related adverse effects during pediatric EGD procedures performed under GA with the EM between June 2014 and March 2015...
June 2016: Paediatric Anaesthesia
Melih Çayönü, Dursun Fırat Ergül, Mehmet Çelik, Funda Durmaz, Arif Hikmet Çatakoğlu, Mustafa Erdoğan
OBJECTIVES: This study aims to compare the risk of immediate respiratory distress (IRD) during the recovery of anesthesia between the nasal surgery with totally occlusive nasal packing and non-respiratory tract-related surgeries. PATIENTS AND METHODS: A total of 300 patients (180 males, 120 females; mean age 30.1±8.2 years; range 18 to 52 years) were included in the study. The patients were assigned to one of two age- and sex-matched groups according to surgery type: 1) patients undergoing nasal surgery with totally occlusive nasal packs for nasal septum deviation or 2) patients undergoing non-respiratory tract surgeries for various diseases...
May 2016: Kulak Burun Boğaz Ihtisas Dergisi: KBB, Journal of Ear, Nose, and Throat
Kai Song, Zhen Rong, Xianfeng Yang, Yao Yao, Yeshuai Shen, Dongquan Shi, Zhihong Xu, Dongyang Chen, Minghao Zheng, Qing Jiang
PURPOSE: Postoperative pulmonary complications (PPCs) are common after major surgeries. However, the number of studies regarding PPCs following total knee arthroplasty (TKA) is limited. The aim of this study was to determine the incidence of early PPCs following TKA by computed tomography (CT) scan and to identify associated risk factors. METHODS: Patients, who were diagnosed with osteoarthritis or rheumatoid arthritis and underwent primary TKA at our institution, were included in this prospective cohort study...
2016: BioMed Research International
Yuko Matsuoka, Satoshi Tanaka, Takanobu Hirabayashi, Mikito Kawamata
We here report a case in which tracheal stent insertion was performed using veno-venous extracorporeal membrane oxygenation (V-V ECMO). A 78-year-old man with severe tracheal stenosis due to thyroid cancer was suffering from dyspnea at rest. Computed tomography showed that the narrowest caliber of the trachea was 1.5 mm in diameter at 5 cm below the level of the vocal cords. Femoro-femoral V-V ECMO was established without hemodynamic instability. General anesthesia was induced with propofol 70 mg and fentanyl 50 μg and was maintained with propofol 150-200 mg x hr(-1) and remifentanil 0...
February 2016: Masui. the Japanese Journal of Anesthesiology
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