Anesthesiology
-
Randomized Controlled Trial
Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial.
Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (<44 mmHg) with patients under routine care. ⋯ Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.
-
Review
Role of transient receptor potential and acid-sensing ion channels in peripheral inflammatory pain.
Pain originating in inflammation is the most common pathologic pain condition encountered by the anesthesiologist whether in the context of surgery, its aftermath, or in the practice of pain medicine. Inflammatory agents, released as components of the body's response to peripheral tissue damage or disease, are now known to be collectively capable of activating transient receptor potential vanilloid type 1, transient receptor potential vanilloid type 4, transient receptor potential ankyrin type 1, and acid-sensing ion channels, whereas individual agents may activate only certain of these ion channels. These ionotropic receptors serve many physiologic functions-as, indeed, do many of the inflammagens released in the inflammatory process. Here, we introduce the reader to the role of these ionotropic receptors in mediating peripheral pain in response to inflammation.
-
Coronary revascularization of the suspected culprit coronary lesion assessed by preoperative stress testing is not associated with improved outcome in vascular surgery patients. ⋯ There was a poor correlation between the locations of preoperatively assessed stress-induced NWMAs by dobutamine echocardiography and those observed intraoperatively using transesophageal echocardiography. However, the composite endpoint of outcome was met more frequently in relation with intraoperative NWMAs.
-
Comparative Study
Lung ventilation and perfusion in prone and supine postures with reference to anesthetized and mechanically ventilated healthy volunteers.
The literature on ventilation (V) and lung perfusion (Q) distributions during general anesthesia and controlled mechanical ventilation in supine and prone position is contradictory. The authors aimed to investigate whether V, Q, and ventilation to perfusion ratio (V/Q ratio) matching in anesthetized and mechanically ventilated volunteers are gravity dependent irrespective of posture. ⋯ During mechanical ventilation, prone posture favors a more evenly distributed Q between lung regions. V distribution is independent of posture. This results in a tendency toward lower V/Q gradients in the ventral to dorsal direction in prone compared with supine posture.