staged extubation

E Cervi, C Ong
The multidisciplinary team brief and effective clinical decision-making are critical to airway surgery. To illustrate this, we present the case of a 58-year-old female with papillary thyroid cancer invading the trachea. We describe a basic framework that was used to aid planning the management of this patient. Tracheal resection is a complex airway operation requiring the evaluation of airway obstruction risk, the formulation of strategies for complex airway management and lung ventilation during complete resection of the tracheal segment and a handover plan for safe tracheal extubation...
January 2020: Anaesthesia reports
Gita N Mody, Anthony Coppolino, Steve K Singh, Hari R Mallidi
The purpose of this report is to provide an updated description of the technique of bilateral sequential lung transplant via median sternotomy. A sternotomy provides the advantage of less morbidity than the clamshell incision, as well as exposure to perform mechanical circulatory support and concurrent cardiac procedures. Our experience shows that lung transplantation via a midline sternotomy can be done with equivalent to better short-term outcomes than a clamshell incision, including earlier extubation and fewer transfusions...
January 2020: Annals of Cardiothoracic Surgery
Ruggero M Corso, Massimiliano Sorbello, Daniela Mecugni, Matteo Seligardi, Emanuele Piraccini, Vanni Agnoletti, Emiliano Gamberini, Stefano Maitan, Tommaso Petitti, Rita Cataldo
BACKGROUND: A safe extubation is the extension of any airway management strategy. Despite different guidelines, a number of extubation accidents still occurs. Re-intubation failure could be fatal, thus a strategy and safe and efficient devices for this purpose are essential. METHODS: Multicentric prospective observational study on adult patients with endotracheal intubation and known difficult airway. A Staged Extubation Set® (SES) was used for extubation. Demographics, ASA, El Ganzouri, type of surgery, re-intubation success/failure and complications were recorded...
March 6, 2020: Minerva Anestesiologica
Ilknur Suidiye Yorulmaz, Yavuz Demiraran, Onur Özlü, Burhan Dost
BACKGROUND: This study is aimed to investigate the effects of vitamin D levels on sugammadex and neostigmine reversal times. METHODS: Eighty patients between the ages of 18 and 65 years, with ASA I-III status who were undergoing surgery under general anaesthesia were included in the study. A double blind fashion was used to randomly divide all the patients into two groups. At the end of the operation, sugammadex 2 mg / kg was administered to one group (Group sugammadex) and atropine and neostigmine was administered to the other group Group neostigmine) intravenously...
March 10, 2020: Turkish Journal of Medical Sciences
Jorge A Almario Alvarez, Obi Okoye, Kiara Tulla, Mario Spaggiari, Pierpaolo Di Cocco, Enrico Benedetti, Ivo Tzvetanov
BACKGROUND: With increased demand for liver transplantation, sicker patients are being transplanted frequently. These patients are at a higher risk of significant postoperative morbidity, including respiratory failure. This study evaluated the phenotype that characterizes liver transplant candidates who may benefit from early tracheostomy. METHODS: A single center retrospective review of all liver transplant candidates between January 2012 and December 2017. Patients who eventually required tracheostomies were identified and compared to their counterparts...
March 2, 2020: Transplantation Proceedings
Zhihua Guo, Pengcheng Cui, Daqing Zhao, Leping Liang, Jing Yang, Qianqian Zhao, Wei Wang, Yuan Xing
Objective: The aim of this study is to o explore the diagnosis, treatment and prognosis of idiopathic subglottic stenosis (ISS) Method: The clinical data of 15 patients with idiopathic subglottic stenosis treated in our department were analyzed retrospectively. The degree of stenosis was classified by the Cotton Airway grading system of Myer, with 8 cases of gradeⅡ, 4 cases of grade Ⅲ and 3 cases of grade Ⅳ. Result: The time of follow-up of HTSS was 0.5-10 years. All 15 patients were successfully extubated without asphyxia, decannulation and wound nonunion...
February 2020: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Ricardo B V Fontes, Ryan B Kochanski, Mena G Kerolus, Rajeev K Garg, Anthony DelaCruz, Vincent C Traynelis
Purpose: Airway obstruction after post-operative extubation is a dreaded but uncommon complication in patients undergoing circumferential cervical spine surgery(CCSS).The cuff leak test(CLT)has been utilized to assess air leak around the endotracheal tube(ETT) which may reflect airway swelling.In this prospective observational study,we analyze the temporal evolution of CLT and perioperative factors that may influence it. Methods: Twenty patients undergoing single-stage CCSS were managed according to our extubation protocol...
February 2, 2020: Neurospine
Shu Y Lu, Yvonne Lai, Adam A Dalia
The use of Enhanced Recovery After Surgery (ERAS) protocols among various surgical subspecialties is increasing, including in cardiac surgery. The goal of these protocols is to optimize patient outcomes and satisfaction and improve the value of healthcare delivered. Cardiac ERAS protocols are divided into the following 3 stages of perioperative care: preoperative, intraoperative, and postoperative. ERAS strategies have been shown to work synergistically to reduce the length of hospital stay, postoperative complications, hospital cost, and opioid consumption; increase patient satisfaction; and result in less and early extubation...
December 27, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Sintaro Tsuge, Akihito Wada, Yasuaki Iida, Yasuhiro Inoue, Katsunori Fukutake, Yuji Nishiwaki, Hiroshi Takahashi
STUDY DESIGN: The present study is a single-center retrospective cohort study. OBJECTIVE: The objective of the study is to verify the hypothesis that sharp elevation of systolic blood pressure at extubation is a risk factor for development of symptomatic epidural hematoma after spinal surgery. SUMMARY OF BACKGROUND DATA: Postoperative symptomatic epidural hematoma (she) after spine surgery is a rare but potentially serious complication that may result in paralysis unless removed at an early stage...
September 2019: Journal of Orthopaedic Surgery
Nadine Rady, Ashwini Kini, Jonathan A Go, Bayan Al Othman, Andrew G Lee
Purpose: Recognize a rare yet existing risk of severe visual loss as a postoperative complication of bilateral lung transplant. Observations: A 62-year-old male had undergone bilateral lung transplant for end-stage idiopathic pulmonary fibrosis and emphysema overlap syndrome. The operation was initially off-pump; however, during the left lung transplantation, cardiopulmonary bypass conversion was necessary to maintain intraoperative hemodynamic stability. On post-operative day 4, shortly after extubation and full recovery from sedation, the patient reported bilateral no light perception vision...
December 2019: American Journal of Ophthalmology Case Reports
Aamir Furqan, Shumaila Ali Rai, Liaqat Ali, Rana Altaf Ahmed
Objective: To compare the predicted accuracy of PFR with RSBI for successful spontaneous breathing trial before extubation in intensive care unit. Methods: This cross sectional study was conducted at the ICU of Ch. Pervaiz Ellahi Institute of Cardiology, Multan Medical and Nishtar Medical University Hospital from July, 2017 to January, 2019.PO2 /FIO2 and RSBI was measured by a different investigator, before and 20 minutes after the start of SBT. Heart rate, blood pressure and oxygen saturation were continuously measured throughout the trial...
November 2019: Pakistan Journal of Medical Sciences Quarterly
Jin Young Chon, Hye Young Moon, Sangbin Han, Jueun Kwak, Ji Young Lee, Eun Sung Kim, Hyun Sik Chung
RATIONALE: Hepatectomy is a treatment to increase survival and curability of patients with intrahepatic lesions or malignant tumors. However, posthepatectomy liver failure (PHLF) can occur. This case is a patient showing acute mental change in postanesthetic care unit (PACU) as an uncommon symptom of PHLF after extended right hepatectomy. PATIENT CONCERNS: A 68-year-old male patient was admitted for surgery of Klatskin tumor. He had hypertension and atrial fibrillation...
November 2019: Medicine (Baltimore)
Elmari Neethling, Jacobo Moreno Garijo, Thiruthani K Mangalam, Mitesh V Badiwala, Phyllis Billia, Marcin Wasowicz, Adriaan Van Rensburg, Peter Slinger
The gold standard treatment for end-stage heart failure, with 50% mortality within 5 years of diagnosis, is considered heart transplantation. Despite the improvements in immunosuppression, the period of highest mortality risk in the heart transplantation population is during the first year post-transplantation, with primary graft dysfunction being the leading cause of mortality. After adequate preoperative assessment of the recipient, including patients on mechanical support, the intraoperative care of heart transplantation patients requires extensive monitoring followed by proficient management of anesthesia induction and maintenance, ventilation, and fluid therapy...
October 2, 2019: Journal of Cardiothoracic and Vascular Anesthesia
D R Adams, L E Tollinche, C B Yeoh, J Artman, M Mehta, D Phillips, G W Fischer, J J Quinlan, T Sakai
Sugammadex is a novel reversal agent for aminosteroid neuromuscular blocking drugs, especially rocuronium. Given its renal excretion, sugammadex is not recommended for patients with end-stage renal disease; however, reports exist of its use in this group of patients. This two-institutional retrospective observational study aimed to review the safety profile and effectiveness of sugammadex in surgical patients with end-stage renal disease who required pre-operative renal replacement therapy. Adult surgical patients with end-stage renal disease requiring pre-operative renal replacement therapy, who received sugammadex between April 2016 and January 2019, were studied...
November 12, 2019: Anaesthesia
Lilun Li, David Strum, Sophie R Pestieau, George Zalzal, Diego Preciado
OBJECTIVES: Single-stage laryngotracheal reconstruction (SS-LTR) requires a period of post-operative intubation, during which time adequate sedation is needed to ensure graft healing. Commonly used agents include benzodiazepines, opioids, and more recently, dexmedetomidine, a centrally-acting α2 adrenoreceptor. This study aims to compare withdrawal outcomes between various sedation regimens following SS-LTR. METHODS: Retrospective chart review of 56 patients who underwent SS-LTR between 2008 and 2018 at a tertiary free-standing children's hospital was performed...
February 2020: International Journal of Pediatric Otorhinolaryngology
Hilal Al Mandhari, Michael Finelli, Shiyi Chen, Christopher Tomlinson, Mika L Nonoyama
Background and objectives: Extubation readiness testing (ERT) in the Neonatal Intensive Care Unit (NICU) is highly variable and lacking standardized criteria. To address this gap, an evidence-based, inter-professionally developed ERT protocol was implemented to assess effectiveness on extubation failure within 72 h and on duration of intubation (DOI). Methods: A longitudinal retrospective chart review in a level III, fully outborn NICU, of intubated infants admitted 1-year prior (Group 1), and 1 year after implementation (Group 2)...
2019: Canadian Journal of Respiratory Therapy: CJRT
C Unterbuchner, K Ehehalt, B Graf
BACKGROUND: Postoperative residual neuromuscular block (train of four ratio <0.9) is an outcome-relevant problem in balanced anesthesia, which increases postoperative morbidity and mortality. Implementation of medium and short-acting muscle relaxants, quantitative neuromuscular monitoring and pharmacological reversal of muscle relaxation reduce the incidence of residual neuromuscular block. The question arises whether this is suitable to create a pragmatic algorithm integrating these three individual methods to reduce paralysis-associated complications? METHODS: A selective literature search was carried out in PubMed and guidelines of national specialist societies were searched using special terms...
November 2019: Der Anaesthesist
Young-Il Jeong, In-Gu Jun, Seung-Soo Ha, Hyun-Jung Kwon, Yu-Mi Lee
INTRODUCTION: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS: Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy...
October 2019: Medicine (Baltimore)
Y H Fu, X Min, W S Zhou, P Long, Y P Xiong
Objective: To investigate the effect of laryngeal reconstruction in functional and anatomical aspect with ultrathin titanium mesh and myofascial flap in patients underwent frontolateral vertical partial laryngectomy with T2 and T3 glottic laryngeal carcinoma. Method: Ten patients with T2 and T3 glottic laryngeal carcinoma underwent frontolateral vertical partial laryngectomy in different range. The ultrathin titanium mesh was shaped up according to the form of thyroid cartilage in operation while the thyroid perichondrium membrane combined with straped myofascial flap was lined under the titanium mesh to restore the laryngeal cavity space...
October 2019: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Bishr Haydar, Anne Baetzel, Margaret Stewart, Terri Voepel-Lewis, Shobha Malviya, Robert Christensen
BACKGROUND: Transporting patients under anesthesia care incurs numerous potential risks, especially for those with critical illness. The purpose of this study is to identify and report all pediatric anesthesia transport-associated adverse events from a preexisting database of perioperative adverse events. METHODS: An extract of the Wake Up Safe database was obtained on December 14, 2017, and screened for anesthesia transport-associated complications. This was defined as events occurring during or immediately after transport or movement of a pediatric patient during or in proximity to their care by anesthesiologists, including repositioning and transfer to recovery or an inpatient unit, if the cause was noted to be associated with anesthesia or handover...
September 27, 2019: Anesthesia and Analgesia
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