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Mechanical Ventilation Anesthesia

Rafael Arboleda Salazar, Jane Heggie, Piotr Wolski, Eric Horlick, Mark Osten, Massimiliano Meineri
BACKGROUND: Twenty percent of patients born with congenital heart disease present with right ventricular outflow tract abnormalities. These patients require multiple surgical procedures in their lifetime. Transcatheter pulmonary valve replacement (TPVR) has become a viable alternative to conventional pulmonary valve and right ventricular outflow tract surgery in pediatric and adult populations. In this retrospective review, we analyze the perioperative management of adult patients who underwent TPVR in our center...
March 14, 2018: Anesthesia and Analgesia
W Scott Beattie, Duminda N Wijeysundera, Matthew T V Chan, Philip J Peyton, Kate Leslie, Michael J Paech, Daniel I Sessler, Sophie Wallace, Paul S Myles, W Galagher, C Farrington, A Ditoro, S Baulch, S Sidiropoulos, R Bulach, D Bryant, E O'Loughlin, V Mitteregger, S Bolsin, C Osborne, R McRae, M Backstrom, R Cotter, S March, B Silbert, S Said, R Halliwell, J Cope, D Fahlbusch, D Crump, G Thompson, A Jefferies, M Reeves, N Buckley, T Tidy, T Schricker, R Lattermann, D Iannuzzi, J Carroll, M Jacka, C Bryden, N Badner, M W Y Tsang, B C P Cheng, A C M Fong, L C Y Chu, E G Y Koo, N Mohd, L E Ming, D Campbell, D McAllister, S Walker, S Olliff, R Kennedy, A Eldawlatly, T Alzahrani, N Chua, R Sneyd, H McMillan, I Parkinson, A Brennan, P Balaji, J Nightingale, G Kunst, M Dickinson, B Subramaniam, V Banner-Godspeed, J Liu, A Kurz, B Hesler, A Y Fu, C Egan, A N Fiffick, M T Hutcherson, A Turan, A Naylor, D Obal, E Cooke
BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk...
March 12, 2018: Anesthesia and Analgesia
Abirami Kumaresan, Robert Gerber, Ariel Mueller, Stephen H Loring, Daniel Talmor
BACKGROUND: The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients. METHODS: We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade...
March 9, 2018: Anesthesiology
Pawan Kumar Hamal, Puspa Raj Poudel, Janith Singh
BACKGROUND: Bone cement implantation syndrome is a known complication causing mortality during perioperative period particularly in patients with malignancy. With rise in aging population with malignancy in low income country, the syndrome is more likely to be encountered. CASE PRESENTATION: We present a case of 66 years old male patient with metastatic bronchogenic carcinoma of lung with pathological proximal femur fracture of left hip that underwent a cemented endoprosthesis under combined spinal epidural anesthesia who succumbed to intraoperative mortality due to grade III bone cement implantation syndrome even after aggressive fluid resuscitation, vasopressor use, and mechanical ventilation...
March 2, 2018: BMC Anesthesiology
Ben Korman, Ranjan K Dash, Philip J Peyton
BACKGROUND: Recent clinical studies suggest that the magnitude of the second gas effect is considerably greater on arterial blood partial pressures of volatile agents than on end-expired partial pressures, and a significant second gas effect on blood partial pressures of oxygen and volatile agents occurs even at relatively low rates of nitrous oxide uptake. We set out to further investigate the mechanism of this phenomenon with the help of mathematical modeling. METHODS: Log-normal distributions of ventilation and blood flow were generated representing the range of ventilation-perfusion scatter seen in patients during general anesthesia...
February 26, 2018: Anesthesiology
Mirko Mihalj, Dajana Vladić, Zoran Karlović, Željka Zadro, Višnja Majerić Kogler
Many papers have been published investigating the effects of intraoperative mechanical ventilation on the incidence of intra- and postoperative respiratory complications. The potential advantages of protective pressure over volume-controlled ventilation mode during laparoscopic surgery have yet to be proven. This study included 60 patients aged between 18 and 70 with ASA score 1-3, body mass index (BMI) ≤35 kg/m2, and without prior history of chronic respiratory diseases, who were scheduled for laparoscopic cholecystectomy under general anesthesia...
September 2017: Acta Clinica Croatica
Julie Wagner, Karl M Strosing, Sashko G Spassov, Ziwei Lin, Helen Engelstaedter, Sabine Tacke, Alexander Hoetzel, Simone Faller
Mechanical ventilation is a life-saving clinical treatment but it can induce or aggravate lung injury. New therapeutic strategies, aimed at reducing the negative effects of mechanical ventilation such as excessive production of reactive oxygen species, release of pro-inflammatory cytokines, and transmigration as well as activation of neutrophil cells, are needed to improve the clinical outcome of ventilated patients. Though the inhaled anesthetic sevoflurane is known to exert organ-protective effects, little is known about the potential of sevoflurane therapy in ventilator-induced lung injury...
2018: PloS One
Kristyna Buzkova, Martin Muller, Ales Rara, Karel Roubik, Tomas Tyll
BACKGROUND AND AIMS: During laparoscopic surgery, a capnoperitoneum is created to optimize the operating space for surgeons. One effect of this is abdominal pressure which alters the physiological thoraco-abdominal configuration and pushes the diaphragm and lungs cranially. Since the lung image acquired by electrical impedance tomography (EIT) depends on the conditions within the thorax and abdomen, it is crucial to know the diaphragm position to determine the effect of diaphragm shift on EIT thorax image...
February 21, 2018: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
Erland Östberg, Arnar Thorisson, Mats Enlund, Henrik Zetterström, Göran Hedenstierna, Lennart Edmark
BACKGROUND: Various methods for protective ventilation are increasingly being recommended for patients undergoing general anesthesia. However, the importance of each individual component is still unclear. In particular, the perioperative use of positive end-expiratory pressure (PEEP) remains controversial. The authors tested the hypothesis that PEEP alone would be sufficient to limit atelectasis formation during nonabdominal surgery. METHODS: This was a randomized controlled evaluator-blinded study...
February 19, 2018: Anesthesiology
Yutaka Oda, Michie Fujita, Chika Motohisa, Shinichi Nakata, Motoko Shimada, Ryushi Komatsu
Background: Ovarian vein thrombosis is a rare complication of pregnancy. The representative complaints of patients with ovarian vein thrombosis are abdominal pain and fever. In some cases, however, fatal pulmonary embolism may develop. We report a case of pulmonary embolism presenting with severe hypotension and loss of consciousness during cesarean section possibly caused by ovarian vein thrombosis. Case presentation: A 25-year-old woman at 38 weeks 4 days of gestation was scheduled for repeat cesarean section...
2018: JA Clin Rep
P Palumbo, S Usai, C Amatucci, B Perotti, L Ruggeri, G Illuminati, G Tellan
BACKGROUND: The extension of indications for procedures in a Day Surgery (DS) setting has led to changes in the anesthetic and surgical treatment of Inguinal Hernias (IH). According to the recommendations of the European Hernia Society, the treatment of IH in DS units should be performed under Monitored Anesthesia Care (MAC). PATIENTS AND METHODS: 960 patients underwent IH repairs over a period of 24 months. The patients were randomly divided into two groups: R (remifentanil) and F (fentanyl); the group F was considered as a control group...
November 2017: Il Giornale di Chirurgia
Priya Bhaskar, Mallikarjuna Rettiganti, Jeffrey M Gossett, Punkaj Gupta
Background: The existing training pathways to become a pediatric cardiac intensivist are very variable with physicians coming from varied training backgrounds of pediatric critical care, pediatric cardiology, neonatology, or pediatric anesthesia. Aim: To evaluate the impact of cardiac Intensive Care Unit (ICU) attending physician training background on outcomes in children undergoing heart operations. Setting and Design: Patients in the age group from 1 day to 18 years undergoing heart operation at a Pediatric Health Information System database participating hospital were included (2010-2015)...
January 2018: Annals of Pediatric Cardiology
Joao Henrique Neves Soares, Alysson Roncally Carvalho, Bruno Curty Bergamini, Maria Alice Kuster Gress, Frederico Caetano Jandre, Walter Araujo Zin, Antonio Giannella-Neto
PURPOSE: We compared respiratory mechanics between the positive end-expiratory pressure of minimal respiratory system elastance (PEEP minErs ) and three levels of PEEP during low-tidal-volume (6 mL/kg) ventilation in rats. METHODS: Twenty-four rats were anesthetized, paralyzed, and mechanically ventilated. Airway pressure (P aw ), flow (F), and volume (V) were fitted by a linear single compartment model (LSCM) P aw (t) = E rs × V(t) + R rs × F(t) + PEEP or a volume- and flow-dependent SCM (VFDSCM) P aw (t) = (E 1 + E 2 × V(t)) × V(t) + (K 1 + K 2 × |F(t)|) × F(t) + PEEP, where E rs and R rs are respiratory system elastance and resistance, respectively; E 1 and E 2 × V are volume-independent and volume-dependent E rs , respectively; and K 1 and K 2 × F are flow-independent and flow-dependent R rs , respectively...
February 12, 2018: Lung
Philipp Baumann, Susanne Wiegert, Francesco Greco, Sven Wellmann, Pietro L'Abate, Vincenzo Cannizzaro
Mechanical ventilation (MV) is routinely used in pediatric general anesthesia and critical care, but may adversely affect the cardiocirculatory system. Biomarkers are increasingly measured to assess cardiovascular status and improve clinical treatment decision-making. As the impact of mechanical ventilation strategies on cardiovascular biomarkers in ventilated infants is largely unknown, we conducted this retrospective study in a healthy in vivo infant rat ventilation model using 14-days old Wistar rats. We hypothesized that 2 h of mechanical ventilation with high and low positive end-expiratory pressure (PEEP), hyperoxemia, hypoxemia, hypercapnia, and hypocapnia would significantly impact B-type natriuretic peptide (BNP), vascular endothelial growth factor (VEGF), and endothelin-1 (ET-1)...
January 2018: Physiological Reports
Tomohisa Yamamoto, Tatsushige Iwamoto, Seishi Kimura, Shinichi Nakao
BACKGROUND: Postoperative cognitive dysfunction (POCD) is likely to occur in elderly people, who often suffer from cerebral hypoperfusion and white matter lesions even in the absence of cerebral infarctions. METHODS: Thirty-two adult male rats were randomly assigned to one of four groups: the cerebral normoperfusion + normotension group (n = 8), cerebral normoperfusion + hypotension group (n = 8), chronic cerebral hypoperfusion (CCH) + normotension group (n = 8), and CCH + hypotension group (n = 8)...
January 25, 2018: Journal of Anesthesia
Ting Zhou, Zhihong Yu, Ming-Yuan Jian, Israr Ahmad, Carol S Trempus, Brant M Wagener, Jean-Francois Pittet, Saurabh Aggarwal, Stavros Garantziotis, Weifeng Song, Sadis Matalon
Acid (HCl) aspiration during anesthesia may lead to acute lung injury. There is no effective therapy. We hypothesized that HCl, instilled intratracheally in C57BL/6 mice results in the formation of low molecular weight hyaluronan (L-HA), which activates RhoA and ROCK, causing airway hyperresponsiveness (AHR) and increased permeability. Furthermore, instillation of high molecular weight hyaluronan (H-HA; Yabro®), will reverse lung injury. We instilled HCl in C57BL/6 wild type, MPO-/- and CD44-/- mice. WT mice were also instilled intranasally with H-HA (Yabro®) at 1 and 23 h post HCl...
January 25, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
Balaji Kuppuswamy, Kirubakaran Davis, Raj Sahajanandan, Manickam Ponniah
OBJECTIVE: The objective of the study is to compare the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass (CPB), the cardio protection been assessed by changes in N-terminal brain natriuretic peptide (NT proBNP). Methodology and Design: This study is designed as a participant blinded, prospective randomized clinical trial. SETTING: Christian Medical College Hospital, Vellore, India...
January 2018: Annals of Cardiac Anaesthesia
Lucía Gallego-Ligorit, Marc Vives, Jorge Vallés-Torres, T Alberto Sanjuán-Villarreal, Azucena Pajares, Mario Iglesias
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus...
December 2, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Mark Jeon, Khursheed R Mama, Jeffrey R Zuba, Nadine Lamberski, James E Oosterhuis, Meredith M Clancy, Katie W Delk, Matthew E Kinney, Patrick J Morris, Francisco Olea-Popelka
Rhinoceros conservation efforts are essential to the survival of the species. One such effort is focused on using advanced reproductive technologies to produce viable northern white rhinoceros ( Ceratotherium simum cottoni) embryos for implantation into southern white rhinoceros ( Ceratotherium simum simum) surrogates. Anesthesia may be required to facilitate necessary procedures in these surrogate rhinoceros, but commonly reported side effects including hypercapnia and hypoxemia limit anesthetic recumbency time due to animal safety concerns...
December 2017: Journal of Zoo and Wildlife Medicine: Official Publication of the American Association of Zoo Veterinarians
Samie Asghar, Faisal Shamim
A young male underwent decompressive craniotomy for an intracerebral bleed. A right-sided subclavian central venous catheter was placed in the operating room after induction of anesthesia. Postoperatively, he was shifted to Intensive Care Unit (ICU) for mechanical ventilation due to low Glasgow coma scale. He had an episode of severe agitation and straining on the tracheal tube in the evening same day. On the 2nd postoperative day in ICU, his airway pressures were high, and chest X-ray revealed massive pleural effusion on right side...
October 2017: Anesthesia, Essays and Researches
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