Articles: cations.
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Anesthesia and analgesia · Feb 2025
Meta Analysis Comparative StudySecond-Generation Supraglottic Airway Devices Versus Endotracheal Intubation in Adults Undergoing Abdominopelvic Surgery: A Systematic Review and Meta-Analysis.
Second-generation supraglottic airway (SGA) devices are widely used, but thought to have inferior safety performance to endotracheal tubes (ETTs), but might be equally efficacious while improving patient-centered outcomes. We compared second-generation SGAs with ETTs for perioperative safety, efficacy, and quality of recovery in adults undergoing abdominopelvic surgery under general anesthesia. Our primary objective was to assess safety in the form of major airway complications. Secondary objectives were other safety, efficacy, and quality of recovery outcomes. ⋯ Second-generation SGAs reduce the risk of major airway complications compared with ETTs in adults undergoing abdominopelvic procedures under general anesthesia, with no reported clinically relevant differences in the risk of regurgitation or pulmonary aspiration. Additionally, they improve the quality of postoperative recovery with lower risk of sore throat, hoarseness, and postoperative nausea and vomiting. These data provide an opportunity for clinicians to reassess the implications of conservative airway management, and potentially expand the role of second-generation SGAs in routine clinical practice.
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Curr Opin Crit Care · Feb 2025
ReviewAdvances in achieving lung and diaphragm-protective ventilation.
Mechanical ventilation may have adverse effects on diaphragm and lung function. Lung- and diaphragm-protective ventilation is an approach that challenges the clinician to facilitate physiological respiratory efforts, while maintaining minimal lung stress and strain. Here, we discuss the latest advances in monitoring and interventions to achieve lung- and diaphragm protective ventilation. ⋯ Achieving lung- and diaphragm-protective ventilation may require more than a single intervention; it demands a comprehensive understanding of the (neuro)physiology of breathing and mechanical ventilation, along with the application of a series of interventions under close monitoring. We suggest a bedside-approach to achieve lung- and diaphragm protective ventilation targets.
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With the growing use of glucagon-like-peptide-1 (GLP-1) receptor (GLP-1R) agonists as anti-obesity medication it is becoming increasingly important to examine its consequences in the peri-operative period. GLP-1R agonists are known for their effects of glucose-lowering and gastroparesis the latter causing some safety concerns regarding induction of anaesthesia, more specifically the risk of pulmonary aspiration. ⋯ Current evidence makes us assume there is indeed an increased level of gastroparesis, but there are no studies to date with evidential confirmation of a presumed elevated risk of pulmonary aspiration. Future perspectives should focus on the actual risk of pulmonary aspiration and the possible implementation of ultrasound in the preoperative assessment.
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Objective intraoperative performance metrics are a new resource for the field of surgical data science. In this study, we conducted a comprehensive review to analyze the existing literature on robotic surgical objective performance indicators (OPIs). ⋯ Clinically, OPIs have been used to predict postoperative patient outcomes and measure intraoperative efficiency. OPIs have shown promise in preliminary surgical education and patient outcomes-related studies, and further multicenter collaborative research will be imperative to validate the use of OPIs in the field of surgery.
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Immigrants in the US face unique challenges in accessing healthcare. There have been several studies highlighting some of the barriers that this population faces; however, there is still a lack of robust research on this patient population in the context of surgical access and outcomes. ⋯ This makes it incredibly difficult to identify this population in the first place, resulting in a decreased ability to study this group retrospectively and, therefore, restricting the quantity and quality of research into these vulnerable patients. This article aims to provide a call to action for medical professionals to develop ways to accurately document immigration status in medical records while assuaging the concerns related to this documentation and its implications on patient care and confidentiality.