Anesthesia and analgesia
-
Anesthesia and analgesia · Aug 2019
Observational StudyAirway Management and Clinical Outcomes in External Laryngeal Trauma: A Case Series.
External laryngeal trauma is a rare but potentially fatal event that presents several management challenges. This retrospective observational case series conducted at a level-1 trauma center over a 12-year period consists of 62 cases of acute external laryngeal trauma. Patient demographics, mode and mechanisms of injury, presenting signs and symptoms, initial imaging results, airway management, time to surgical management, and 6-month outcomes including airway status, deglutition status, and voice quality were investigated. No difference was found in mortality or 6-month outcomes between patients requiring surgical repair and/or tracheostomy versus patients with less severe injuries managed conservatively.
-
Anesthesia and analgesia · Aug 2019
Comparative Study Clinical TrialComparison of 7 Different Sensors for Detecting Low Respiratory Rates Using a Single Breath Detection Algorithm in Nonintubated, Sedated Volunteers.
Numerous technologies are used to monitor respiratory rates in nonintubated patients. No technology has emerged as the standard. The primary aim of this study was to assess the limits of agreement between a reference sensor signal (respiratory inductance plethysmography bands) and 7 alternative sensor signals (nasal capnometer, nasal pressure transducer, oronasal thermistor, abdominal accelerometer, transpulmonary electrical impedance, peritracheal microphone, and photoplethysmography) for measuring low respiratory rates in sedated, nonintubated, supine volunteers. A unified approach based on a single breath detection algorithm was applied to each sensor to facilitate comparison. We hypothesized that all of the sensor signals would allow detection of low (<10 breaths per minute) respiratory rates to within ±2 breaths per minute of the reference sensor signal. ⋯ A unified approach can be applied to a variety of sensor signals to estimate respiratory rates in spontaneously breathing, nonintubated, sedated volunteers. However, detecting clinically relevant low respiratory rates (<6 breaths per minute) is a technical challenge. By our analysis, no single sensor was able to detect slow respiratory rates with adequate precision (<±2 breaths per minute of the reference signal). Of the sensors evaluated, capnometers and abdominal accelerometers may be the most reliable sensors for identifying hypopnea and central apnea.
-
Anesthesia and analgesia · Aug 2019
Randomized Controlled Trial Comparative StudyComparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Neonates.
GlideScope video laryngoscope (GS) has been widely used to facilitate tracheal intubation in adults and pediatric patients because it can improve glottic view. Several investigations performed in pediatric patients have shown that GS provides a better view of the glottis than direct laryngoscope (DL). However, to date, there are no studies assessing the use of GS in neonates. Therefore, we conducted a prospective study to compare time to intubate (TTI) when either GS or DL was used for endotracheal intubation in neonates. ⋯ GS use did not decrease the TTI of all neonates and neonates with C&L grades I and II as compared to DL use; however, GS significantly decreased the TTI of neonates with C&L grades III and IV. Additionally, GS use provided improved glottic views.
-
Anesthesia and analgesia · Aug 2019
Comparative Study Observational StudyHeterogeneity Among Hospitals in the Percentages of All Lumbosacral Epidural Steroid Injections Where the Patient Had Received 4 or More in the Previous Year.
Current guidelines for the administration of therapeutic epidural injections suggest that these be limited to a maximum of 4 per year. We sought to gain an understanding of the proportion of lumbosacral epidural injections administered to patients who had received ≥4 such injections during the preceding 364 days, and whether these proportions varied among hospitals. ⋯ Although most patients received only 1 lumbosacral steroid injection within 1 year, 1.27% of patients received 5 or more, and 1.91% of injections were the fifth or greater. Several hospitals had significantly greater than the overall average percent of steroid injections which were fifth or more. This heterogeneity warrants study of whether annual steroid injections per patient should be a clinical quality measure for the care received by patients with lower back pain or whether payment should be greater when injections are in accordance with guidelines.
-
Anesthesia and analgesia · Aug 2019
Observational StudyOutcomes and Safety Among Patients With Obstructive Sleep Apnea Undergoing Cancer Surgery Procedures in a Freestanding Ambulatory Surgical Facility.
Patients with obstructive sleep apnea (OSA) may be at increased risk for serious perioperative complications. The suitability of ambulatory surgery for patients with OSA remains controversial, and several national guidelines call for more evidence that assesses clinically significant outcomes. In this study, we investigate the association between OSA status (STOP-BANG risk, or previously diagnosed) and short-term outcomes and safety for patients undergoing cancer surgery at a freestanding ambulatory surgery facility. ⋯ Our results contribute to the body of evidence supporting that patients with moderate-risk, high-risk, or diagnosed OSA can safely undergo outpatient and advanced ambulatory oncology surgery without increased health care burden of extended stay or hospital admission and avoiding adverse postoperative outcomes. Our results support the adoption of several national OSA guidelines focusing on preoperative identification of patients with OSA and clinical pathways for perioperative management and postoperative monitoring.