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European Journal of Anaesthesiology Jan 2024Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent...
Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong '1' or weak '2' recommendation with high 'A', medium 'B' or low 'C' quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1С). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1С). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO 2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B).
Topics: Infant, Newborn; Infant; Humans; Anesthesiology; Airway Management; Intubation, Intratracheal; Anesthesia, General; Critical Care
PubMed: 38018248
DOI: 10.1097/EJA.0000000000001928 -
European Journal of Anaesthesiology Oct 2023Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and...
Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery.
INTRODUCTION
Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council (ERC) guidelines.
MATERIAL AND METHODS
The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches.
RESULTS
This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage (OCCM), resuscitative endovascular balloon occlusion (REBOA) and resuscitative thoracotomy, pericardiocentesis, needle decompression and thoracostomy.
CONCLUSION
Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well organised team using crew resource management but also on an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary co-operation.
Topics: Humans; Anesthesiology; Balloon Occlusion; Critical Care; Heart Arrest; Resuscitation
PubMed: 37218626
DOI: 10.1097/EJA.0000000000001813 -
Anesthesiology Jun 2024
Topics: Humans; Anesthesiology
PubMed: 38558057
DOI: 10.1097/ALN.0000000000004943 -
Anasthesiologie, Intensivmedizin,... Jul 2023
Topics: Humans; Anesthesia; Anesthesiology; Blood Coagulation Tests
PubMed: 37582351
DOI: 10.1055/a-2101-3320 -
Ugeskrift For Laeger Dec 2023
Topics: Humans; Anesthesia; Anesthesiology
PubMed: 38084619
DOI: No ID Found -
British Journal of Hospital Medicine... Jan 2024Adverse effects of perioperative opioids have led to the pursuit of 'opioid-free anaesthesia'. While early studies have shown that effective analgesia can be achieved...
Adverse effects of perioperative opioids have led to the pursuit of 'opioid-free anaesthesia'. While early studies have shown that effective analgesia can be achieved without using opioids, with some reduction in unwanted effects, further research is needed to elucidate which patients may benefit most and how.
Topics: Humans; Anesthesia; Anesthesiology; Analgesia; Analgesics, Opioid; Drug-Related Side Effects and Adverse Reactions
PubMed: 38300677
DOI: 10.12968/hmed.2023.0344 -
Advances in Anesthesia Dec 2023Anesthesia for patients with life-threatening injuries is an essential part of post-accident care. Unfortunately, there is variability in trauma anesthesia care and... (Review)
Review
Anesthesia for patients with life-threatening injuries is an essential part of post-accident care. Unfortunately, there is variability in trauma anesthesia care and numerous nonstandardized methods of working with patients remain. Uncertainty exists as to when and how best to intubate trauma patients, the use of vasopressors, and the appropriate management of severe traumatic brain injury. Some physicians recommend prehospital rapid sequence intubation, whereas others use bag-mask ventilation at lower pressures with no cricoid pressure and early transport to a trauma center. Overall, the absence of uniformity in trauma anesthesia care underlines the need for continued study and dialogue to define best practices and optimize patient outcomes.
Topics: Humans; Anesthesiology; Anesthesia; Brain Injuries, Traumatic; Physicians; Rapid Sequence Induction and Intubation
PubMed: 38251615
DOI: 10.1016/j.aan.2023.06.003 -
Anasthesiologie, Intensivmedizin,... Jan 2024Patients undergoing challenging medical procedures often suffer from high levels of anxiety and stress. Their most important need is a feeling of control and safety....
Patients undergoing challenging medical procedures often suffer from high levels of anxiety and stress. Their most important need is a feeling of control and safety. Hypnotic communication provides a means of addressing these feelings without medication. The core technique is to use the perceived stimuli, like beeping sounds or the pressure of the ventilation mask and re-evaluate them as helpful signs. For example, the beeping sounds can be an indicator of the optimal treatment with the highest level of medical equipment in the intensive care unit and the pressure of the ventilation mask might feel like a tight hug of a friend that wants to help. Positive suggestions work even better when patients are in a trance state. In the intensive care unit, you can use the natural trance state instead of inducing a formal hypnotic trance. Positive suggestions can even help to prevent negative emotions before the challenging medical procedure starts. It greatly improves patients' well-being to replace common phrases in the everyday medical practice. This article gives examples of better phrasings and elaborates the scientific evidence of positive suggestions that can even stop bleeding. The goal is to show simple ways to improve communication with patients and induce feelings of control and safety.
Topics: Humans; Anesthesia; Anesthesiology; Hypnosis; Anxiety; Hypnotics and Sedatives
PubMed: 38190827
DOI: 10.1055/a-2044-8428 -
Best Practice & Research. Clinical... Sep 2023
Topics: Humans; Ambulatory Surgical Procedures; Anesthesia; Anesthesiology
PubMed: 37938076
DOI: 10.1016/j.bpa.2023.05.001 -
Best Practice & Research. Clinical... Sep 2023Patient selection is important for ambulatory surgical practices. Proper patient selection for ambulatory practices will optimize resources and lead to increased patient... (Review)
Review
Patient selection is important for ambulatory surgical practices. Proper patient selection for ambulatory practices will optimize resources and lead to increased patient and provider satisfaction. As the number and complexity of procedures in ambulatory surgical centers increase, it is important to ensure that patients are best cared for in facilities that can provide appropriate levels of care. This review addresses the multiple variables and resources that should be considered when selecting patients for anesthesia in ambulatory centers and offices.
Topics: Humans; Ambulatory Surgical Procedures; Patient Selection; Anesthesia; Anesthesiology
PubMed: 37938082
DOI: 10.1016/j.bpa.2022.12.005