Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2018
Ventilation strategy and anesthesia management in patients with severe tracheal stenosis undergoing urgent tracheal stenting.
Stenting of airway stenosis is a common procedure in specialized centers. The aim of this study was to summarize our clinical experience in ventilation strategy and anesthesia management of patients undergoing urgent tracheal stenting. ⋯ Establishment of effective airway ventilation in patients with severe tracheal stenosis should be based on the cause, location, and severity of tracheal narrowing. Veno- arterial ECMO may be considered in patients with severe stenosis, if they are judged unable to tolerate conventional ventilation or jet ventilation.
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Acta Anaesthesiol Scand · May 2018
Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy: a feasibility study.
We conducted this study to test whether pulse-oximetry hemoglobin saturation (SpO2 ) can personalize the implementation of an open-lung approach during laparoscopy. Thirty patients with SpO2 ≥ 97% on room-air before anesthesia were studied. After anesthesia and capnoperitoneum the FIO2 was reduced to 0.21. Those patients whose SpO2 decreased below 97% - an indication of shunt related to atelectasis - completed the following phases: (1) First recruitment maneuver (RM), until reaching lung's opening pressure, defined as the inspiratory pressure level yielding a SpO2 ≥ 97%; (2) decremental positive end-expiratory (PEEP) titration trial until reaching lung's closing pressure defined as the PEEP level yielding a SpO2 < 97%; (3) second RM and, (4) ongoing ventilation with PEEP adjusted above the detected closing pressure. ⋯ The non-invasive SpO2 monitoring can help to individualize an open-lung approach, including all involved steps, from the identification of those patients who can benefit from recruitment, the identification of opening and closing pressures to the subsequent monitoring of an open-lung condition.