Articles: general-anesthesia.
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Observational Study
The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study.
Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. ⋯ Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract.
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There are reports that the use of regional anesthesia (RA) may be associated with better perioperative surgical stress response in cancer patients compared with general anesthetics (GA). However, the role of anesthesia on the magnitude of the postoperative systemic inflammatory response (SIR) in colorectal cancer patients, within an enhanced recovery pathway (ERP), is not clear. The aim of the present study was to examine the effect of anesthesia, within an enhanced recovery pathway, on the magnitude of the postoperative SIR in patients undergoing elective surgery for colorectal cancer. ⋯ On multivariate analysis, day 4 postoperative CRP was independently associated with anesthetic technique (OR 0.56; CI 0.32-0.97; P = .039), age (OR 0.74; CI 0.55-0.99; P = .045), smoking (OR 1.58; CI 1.18-2.12; P = .002), preoperative mGPS (OR 1.41; CI 1.08-1.84; P = .012), and preoperative dexamethasone (OR 0.68; CI 0.50-0.92; P = .014). There was a modest but an independent association between RA and a lower magnitude of the postoperative SIR. Future work is warranted with multicenter RCT to precisely clarify the relationship between anesthesia and the magnitude of the postoperative SIR.
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Observational Study
The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery: A retrospective analysis.
Postoperative cognitive dysfunction (POCD) is very common in clinical settings, it is necessary to analyze the risk factors for POCD in elderly patients after laparoscopic surgery to provide insights into clinical surgery management. Elderly patients undergone laparoscopy between September 1, 2018 and March 31, 2020 were included. The mini-mental state examination (MMSE) scale was used to evaluate the POCD, and the characteristics and clinical data of patients with and without POCD were collected and compared. ⋯ There were significant differences in the history of cerebral infarction, preemptive analgesia, preoperative use of dexmedetomidine, general anesthesia combined with continuous epidural block, duration of surgery, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative PCEA and VAS score at the third day after operation (all P < .05). Logistic regression analysis revealed that history of cerebral infarction (OR3.12, 1.02∼5.13), low SpO2 during anesthesia induction (OR2.03, 1.19∼4.47), Longer duration of surgery (OR1.82, 1.01∼3.16) were risk factors for POCD in elderly patients with laparoscopic surgery, while postoperative PCEA (OR0.43, 0.01∼0.91), General anesthesia combined with continuous epidural block (OR0.59, 0.04∼0.87), preoperative use of dexmedetomidine (OR0.70, 0.08∼0.94) and preemptive analgesia (OR0.75, 0.13-0.90) were the protective factors for POCD in elderly patients with laparoscopic surgery. For the elderly patients undergoing laparoscopic surgery, the health care providers should be fully alert to the POCD based on those relevant factors.
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This study aimed to identify the risk factors and evaluate the prognosis of unplanned reintubation caused by acute airway compromise (AAC) after general anesthesia. ⋯ Age > 65, ASA physical status 3, head-neck or thoracic surgery and high fluid load were found to be associated with AAC-caused unplanned reintubation.