Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2021
Context-sensitive decrement times for inhaled anesthetics in obese patients explored with Gas Man®.
Anesthesia care providers and anesthesia decision support tools use mathematical pharmacokinetic models to control delivery and especially removal of anesthetics from the patient's body. However, these models are not able to reflect alterations in pharmacokinetics of volatile anesthetics caused by obesity. The primary aim of this study was to refine those models for obese patients. ⋯ With increasing obesity, recovery and resolution times were higher. The additional adipose tissue in obese simulation models did not prolong awakening times and thus may act more like a sink for volatile anesthetics. The results of these simulations should be validated by comparing the elimination of volatile anesthetics in obese patients with data from our simulation models.
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J Clin Monit Comput · Apr 2021
Observational StudyUltrasonography for predicting a difficult laryngoscopy. Getting closer.
Our objective was to evaluate the usefulness of five ultrasound measurements to predict a difficult laryngoscopy (DL). Prospective observational study. 50 patients underwent scheduled surgery under general anesthesia with orotracheal intubation with classical laryngoscopy at the University Hospital of Jaén (Spain). Sociodemographic variables, classic preintubation screening tests and ultrasound measurements of the neck soft tissue from skin to hyoid (DSH), epiglottis (DSE) and glottis (DSG) were obtained, as well as two measurements derived from the above: DSH + DSE and DSE - DSG. ⋯ It was established that DSE ≥ 3 cm, could predict a DL with a positive predictive value (PPV) of 69.23% [95%CI 40.3-98.2], and DSE - DSG ≥ 1.9 cm would do so with a PPV of 78.57% [95%CI 53.31-100%]. The multivariate analysis endorsed that DSE and DSE - DSG combined with classic tests (the Modified Mallampati score, the thyromental distance and the upper lip bite test) improved the preoperative detection of a DL. The inclusion of DSE and DSE - DSG in a multivariate model with classic parameters may offer the anesthesiologist better information for detecting a DL preoperatively.