Journal of anesthesia
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Airway management in children poses unique challenges due to the different anatomy, physiology, and pathophysiology across the pediatric age span. The recently published joint European Society of Anaesthesiology and Intensive Care-British Journal of Anaesthesia (ESAIC-BJA) neonatal and infant airway management guidelines provide recommendations and suggestions to support clinicians in deciding the best strategy. These guidelines represent a framework with the most recent and up-to-date evidence, from the initial assessment to the management of normal and difficult airways up to the extubation phase. ⋯ Pediatric institutions should adopt guidelines after careful internal review according to the local circumstances, including caseload, equipment and expertise. The current narrative review focused on providing references and practical tips on pediatric airway management, which is still not completely elucidated. Moreover, the authors put particular emphasis on the influence of human factors on the overall success of tracheal intubation, the incidence of complications, and the outcomes for patients.
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Journal of anesthesia · Feb 2025
The effects of frailty on opioid consumption after total knee arthroplasty.
This study evaluated the effects of frailty on postoperative opioid consumption in elderly patients. ⋯ Our study results indicate that frailty, easily assessed preoperatively in elderly surgical patients, is a significant predictor of postoperative opioid consumption.
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Journal of anesthesia · Feb 2025
Post-esophagectomy patients presenting for general anesthesia induction: a survey of practice among US anesthesiologists (PESO-GAIN-S).
Following esophagectomy, annually several thousand patients in the United States (US) reach a stable post-esophagectomy status. Such patients may require general anesthesia (GA) for elective procedures, but no generally accepted guidelines exist for the induction of GA in post-esophagectomy patients. ⋯ US attending anesthesiologists' approach to induction of GA in a patient with a history of successful esophagectomy was not uniform. The majority of responses reflected a concern for aspiration in such a patient. Considering surgical and non-surgical upper gastrointestinal changes, establishment of practice guidance to optimize perioperative care is an unmet need.
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Journal of anesthesia · Feb 2025
Impact of low-dose sevoflurane with propofol-based anesthesia on motor-evoked potentials in infants: a single-arm crossover pilot study.
The influence of anesthetic interactions on motor-evoked potentials in infants has rarely been reported. In infants, adding a small dose of sevoflurane to propofol-based total intravenous anesthesia is reasonable for reducing propofol administration. We collected preliminary data regarding the effect of low-dose sevoflurane in propofol-based total intravenous anesthesia on motor-evoked potentials in infants. ⋯ Adding even 0.1-0.15 age-adjusted minimum alveolar concentration sevoflurane to propofol-based total intravenous anesthesia attenuated the motor-evoked potential amplitudes in the lower extremities. A further prospective interventional study with an appropriate sample size is required to investigate the study hypothesis.