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Hypoxemia during anesthesia

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https://www.readbyqxmd.com/read/28177565/the-impact-of-capnography-monitoring-among-children-and-adolescents-in-the-postanesthesia-care-unit-a-randomized-controlled-trial
#1
Melissa L Langhan, Fang-Yong Li, J Lance Lichtor
BACKGROUND: Pulse oximetry does not reliably recognize respiratory depression, particularly in the presence of supplemental oxygen. Capnography frequently detects hypoventilation and apnea among children recovering from anesthesia. Although children are routinely monitored with capnography during anesthesia, reducing the rate of adverse events, it is not routinely used in the postanesthesia care unit (PACU), where patients remain at risk for respiratory depression. AIM: We hypothesized that children monitored with capnography would have more frequent staff interventions and fewer adverse events than children monitored with pulse oximetry alone...
February 8, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28118413/a-double-blinded-randomized-comparison-of-medetomidine-tiletamine-zolazepam-and-dexmedetomidine-tiletamine-zolazepam-anesthesia-in-free-ranging-brown-bears-ursus-arctos
#2
Núria Fandos Esteruelas, Marc Cattet, Andreas Zedrosser, Gordon B Stenhouse, Susanne Küker, Alina L Evans, Jon M Arnemo
We compared anesthetic features, blood parameters, and physiological responses to either medetomidine-tiletamine-zolazepam or dexmedetomidine-tiletamine-zolazepam using a double-blinded, randomized experimental design during 40 anesthetic events of free-ranging brown bears (Ursus arctos) either captured by helicopter in Sweden or by culvert trap in Canada. Induction was smooth and predictable with both anesthetic protocols. Induction time, the need for supplemental drugs to sustain anesthesia, and capture-related stress were analyzed using generalized linear models, but anesthetic protocol did not differentially affect these variables...
2017: PloS One
https://www.readbyqxmd.com/read/28099321/preoxygenation-physiologic-basis-benefits-and-potential-risks
#3
Usharani Nimmagadda, M Ramez Salem, George J Crystal
Preoxygenation before anesthetic induction and tracheal intubation is a widely accepted maneuver, designed to increase the body oxygen stores and thereby delay the onset of arterial hemoglobin desaturation during apnea. Because difficulties with ventilation and intubation are unpredictable, the need for preoxygenation is desirable in all patients. During emergence from anesthesia, residual effects of anesthetics and inadequate reversal of neuromuscular blockade can lead to hypoventilation, hypoxemia, and loss of airway patency...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28074800/effectiveness-of-ventilation-of-nondependent-lung-for-a-brief-period-in-improving-arterial-oxygenation-during-one-lung-ventilation-a-prospective-study
#4
Keerthi Chigurupati, Suneel Puthuvassery Raman, Unnikrishnan Koraparambil Pappu, Unnikrishnan Madathipat
BACKGROUND: Hypoxemia is common during one-lung ventilation(OLV), predominantly due to transpulmonary shunt. None of the strategies tried showed consistent results. We evaluated the effectiveness of ventilating the operated, non-dependent lung (NDL) with small tidal volumes in improving the oxygenation during OLV. METHODS: 30 ASA 1 and 2 patients undergoing elective, open thoracotomy were studied. After standard induction of anesthesia, lung seperation was acheived with left sided DLT...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28072737/the-efficacy-of-dexmedetomidine-remifentanil-versus-dexmedetomidine-propofol-in-children-undergoing-flexible-bronchoscopy-a-retrospective-trial
#5
Hongquan Zhang, Baojun Fang, Wenjing Zhou
Flexible bronchoscopy has been more and more used for diagnosis and management diseases of respiratory system in pediatrics. Previous studies have reported that remifentanil (RF) and propofol are safe and effective for flexible bronchoscopy in adults, however, there have no trials evaluate the efficacy of DEX-RF versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy.We divided 123 children undergoing flexible bronchoscopy with DEX-RF or dexmedetomidine-propofol into 2 groups: Group DR (n = 63, DEX infusion at 1...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27910802/near-infrared-spectroscopy-evaluated-cerebral-oxygenation-during-anesthesia
#6
Henrik Sørensen
Likely, maintained organ and notably cerebral perfusion, secures rapid recovery following anesthesia. To secure cerebral blood flow (CBF) at least mean arterial pressure (MAP) and the arterial carbon dioxide tension (PaCO2) need to be considered. CBF is "autoregulated", i.e. stays more or less stable within a MAP of 50-150 mmHg, but the lower limit appears to depend on the central blood volume and/or cardiac output, illustrated by a decrease in CBF at a MAP of 80 mmHg with a compromised central blood volume, while CBF remains constant with a MAP < 40 mmHg, if the central blood volume is maintained...
December 2016: Danish Medical Journal
https://www.readbyqxmd.com/read/27871524/predictors-of-desaturation-during-patient-transport-to-the-postoperative-anesthesia-care-unit-an-observational-study
#7
François Labaste, Stein Silva, Léa Serin-Moulin, Etienne Lefèvre, Bernard Georges, Jean-Marie Conil, Vincent Minville
BACKGROUND: The transport of postoperative patients to the postoperative anesthesia care unit (PACU) is a high-risk period for hypoxemia. The aim of this study was to determine risk factors for hypoxemia during transfers to the PACU. METHODS: An observational, prospective, monocentric, and noninterventional study was conducted in the University Hospital of Toulouse in 2015 during a 5-week period. All patients who were transferred to PACU were included. Twenty-eight variables related to patient, surgery, and anesthesia were recorded...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27729704/esmolol-corrects-severe-hypoxemia-in-patients-with-femoro-femoral-venoarterial-extracorporeal-life-support-for-lung-transplantation
#8
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
https://www.readbyqxmd.com/read/27672454/bronchoesophageal-fistula-stenting-using-high-frequency-jet-ventilation-and-underwater-seal-gastrostomy-tube-drainage
#9
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
https://www.readbyqxmd.com/read/27669555/lung-ultrasonography-for-the-assessment-of-perioperative-atelectasis-a-pilot-feasibility-study
#10
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...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27569734/sedation-and-use-of-analgesics-in-endoscopic-retrograde-cholangiopancreatography-a-double-blind-comparison-study-of-meperidine-midazolam-remifentanil-midazolam-and-remifentanil-alone
#11
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/27558533/developing-an-objective-method-for-analyzing-vital-signs-changes-in-neonates-during-general-anesthesia
#12
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
https://www.readbyqxmd.com/read/27552240/preoperative-assessment-of-the-impact-of-positive-pressure-ventilation-with-noninvasive-positive-pressure-ventilation-in-a-patient-with-eisenmenger-syndrome-a-case-study
#13
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...
November 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27473720/transesophageal-lung-ultrasonography-a-novel-technique-for-investigating-hypoxemia
#14
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
https://www.readbyqxmd.com/read/27384980/a-comparison-of-measurements-of-change-in-respiratory-status-in-spontaneously-breathing-volunteers-by-the-exspiron-noninvasive-respiratory-volume-monitor-versus-the-capnostream-capnometer
#15
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...
January 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27314599/propofol-remifentanil-anesthesia-for-upper-airway-endoscopy-in-spontaneous-breathing-patients-the-endotanil-randomized-trial
#16
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
https://www.readbyqxmd.com/read/27290971/age-related-incidence-of-desaturation-events-and-the-cardiac-responses-on-stroke-index-cardiac-index-and-heart-rate-measured-by-continuous-bioimpedance-noninvasive-cardiac-output-monitoring-in-infants-and-children-undergoing-general-anesthesia
#17
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
https://www.readbyqxmd.com/read/27290957/air-q-laryngeal-airway-for-rescue-and-tracheal-intubation
#18
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
https://www.readbyqxmd.com/read/27281065/a-response-surface-model-exploration-of-dosing-strategies-in-gastrointestinal-endoscopies-using-midazolam-and-opioids
#19
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)
https://www.readbyqxmd.com/read/27274092/high-flow-nasal-cannula-versus-bag-valve-mask-for-preoxygenation-before-intubation-in-subjects-with-hypoxemic-respiratory-failure
#20
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
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