Articles: general-anesthesia.
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Anesthesia and analgesia · Mar 2021
Randomized Controlled Trial Multicenter Study Comparative StudyHead Rotation Reduces Oropharyngeal Leak Pressure of the i-gel and LMA® Supreme™ in Paralyzed, Anesthetized Patients: A Randomized Trial.
This airway study is a neat little randomised-but-not-blinded study of the effect of head rotation on the oropharyngeal leak pressure of both the i-gel and LMA Supreme 2nd generation supraglottic airways.
The researchers investigated the leak pressure (OPLP) of the i-gel and LMA Supreme in paralysed patients with the head: 1. neutral, 2. rotated 30°, and 3. rotated 60°. They found that rotation of the head through 30° and 60° progressively increased OPLP by a clinically-significantly amount (0° vs 60° 5.5 cmH2O (3.3-7.8) & 6.5 cmH2O (5.1-8.0) respectively).
Before you get too excited...
The result however may not be reliably applicable to all populations, notably the study subjects were overwhelmingly small (x̄ ~160cm & 60kg) Japanese women (71%), receiving a TIVA muscle-relaxant anaesthetic (propofol, remifentanil, rocuronium). How well this improvement-with-rotation holds up among, for example, spontaneously ventilating large Caucasian males, is unclear.
Bottom-line
When using an i-gel or LMA Supreme 2nd generation supraglottic airway, careful head rotation to 60° may increased oropharyngeal leak pressure and so assist with ventilation troubleshooting. However head and neck rotation of anaesthetised, paralysed patients should be performed gently and cautiously – you are after all, not a chiropractor!
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Anesthesia and analgesia · Mar 2021
Pragmatic Clinical TrialPediatric Distraction on Induction of Anesthesia With Virtual Reality and Perioperative Anxiolysis: A Randomized Controlled Trial.
Perioperative pediatric anxiety is common and can have a negative psychological impact on children undergoing surgery and anesthesia. Studies have shown an incidence of anxiety at induction of up to 50%. Audiovisual distraction, including virtual reality (VR), is a noninvasive, nonpharmacological modality that may reduce perioperative anxiety. The goal of this study was to determine whether immersive audiovisual distraction with a VR headset during induction of general anesthesia (GA) in pediatric patients reduced preoperative anxiety. ⋯ This study demonstrates a reduction in pediatric preoperative anxiety with the use of VR. Preoperative VR may be an effective noninvasive modality for anxiolysis during induction of anesthesia in children.
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An important assessment of the quality of health care is patient satisfaction. However, only few studies are available which look into this aspect. The primary objective of this study was to compare patient satisfaction between regional anaesthesia (RA) and general anaesthesia (GA) in patients undergoing upper limb surgeries. The length of hospital stay and duration of analgesia between the two techniques were the secondary objectives. ⋯ RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.
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Multicenter Study
The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross sectional analysis of six hospitals in the north-west of England.
At the onset of the global pandemic of COVID-19 (SARS-CoV-2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north-west of England. ⋯ Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00-1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision-making, recommendations from anaesthetic guidelines and presence of an on-site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.
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Multicenter Study Comparative Study
Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis.
To date, the choice of optimal anesthetic management during endovascular therapy (EVT) of acute ischemic stroke patients remains subject to debate. We aimed to compare functional outcomes and complication rates of EVT according to the first-line anesthetic management in two comprehensive stroke centers: local anesthesia (LA) versus general anesthesia (GA). ⋯ In this study, systematic use of GA for stroke EVT was associated with better clinical outcomes, higher recanalization rates, and fewer procedural complications compared with patients treated under LA as the primary anesthetic approach.