Manutenção do equilíbrio entre a pressão das vias aéreas e a pressão intracraniana em paciente com estenose traqueal submetido à craniotomia: relato de caso

ResumoJustificativa e objetivosEstenose traqueal é uma doença rara, mas de risco, e a anestesia em paciente com estenose traqueal é um desafio para os anestesiologistas. Manter os parâmetros hemodinâmicos estáveis e a ventilação são questões importantes em neuroanestesia. Qualquer aumento da pressão de pico das vias aéreas e da ETCO2 resultará em aumento da pressão intracraniana, o que deve ser evitado durante craniotomias. A estenose traqueal pode ser uma razão para o aumento da pressão das vias aéreas.Relato de casoDescrevemos o caso de um paciente submetido à craniotomia com estenose traqueal.ConclusãoA preparação detalhada para a intubação, estabilizar a dinâmica das vias aéreas e tomar a decisão certa para a cirurgia foram pontos importantes. Manter um bom equilíbrio entre a dinâmica cerebral e a dinâmica das vias aéreas foi a pérola deste caso.AbstractBackground and objectivesTracheal stenosis is a rare but a life‐threatening condition and anesthesia of a patient with tracheal stenosis is challenging for anesthesiologists. Maintaining stable hemodynamics and ventilation parameters are important issues in neuroanesthesia. Any increase in airway peak pressure and ETCO2 will result in increase in intracranial pressure which must be avoided during craniotomies. Tracheal stenosis could be a reason for increased airway pressure.Case reportWe described a patient undergoing craniotomy with tracheal stenosis.ConclusionDetailed preparation for intubation, to stabilize airway dynamics and to make the right decision for the surgery were important points. To maintain a good balance between cerebral dynamics and airway dynamics were the pearls of this case

Izazovi opstetricijske anestezije: otežana vizualizacija larinksa

Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.Opstetricijska anestezija je visokorizična anesteziološka supspecijalnost. Komplikacije vezane uz anesteziju su šesti vodeći uzrok majčine smrtnosti. Otežana ili nemoguća intubacija nakon uvoda u opću anesteziju je glavni čimbenik koji doprinosi komplikacijama vezanim uz anesteziju rodilja. Zbrinjavanje dišnoga puta u rodilja je izazov iz više razloga. Anatomske i fiziološke promjene u trudnoći povećavaju učestalost otežane i nemoguće intubacije u odnosu na opću kiruršku populaciju. Zadovoljavajuća evaluacija anatomije dišnoga puta i dišnih struktura je životno važna da bi se spriječile katastrofe vezane uz zbrinjavanje dišnoga puta. Uz osnovnu opremu za dišni put i intubaciju svaki anesteziološki odjel mora imati kolica s opremom za otežani dišni put koja uključuju fiberoptički laringoskop, videolaringoskop i različite vrste laringealnih maski. Nužno je da svi anesteziolozi imaju unaprijed osmišljene i dobro razrađene algoritme i opremu za hitno zbrinjavanje dišnoga puta kako bi postupali s hitnoćama dišnoga puta u otežanoj ili nemogućoj intubaciji rodilja

Precision Anaesthesia: Advancing Patient-Centered Precision Care Through Repetitive Assessment of PROMs with the Safe Brain Initiative Approach.

This article aims to introduce the Safe Brain Initiative (SBI) approach, focusing on collecting and leveraging Patient-Reported Outcome Measures (PROMs) to enhance patient-centred precision anaesthesia and prevent postoperative delirium (POD) and neurocognitive disorders (NCD). The SBI was implemented to systematically address the feedback gap in perioperative care by collecting and analysing real-world data. The initiative focuses on monitoring and preventing POD and NCD, providing effective anaesthesia care, assessing patient and team satisfaction, and evaluating environmental sustainability impact. Based on international guidelines, 18 core recommendations were established to address potential complications and challenges associated with anaesthesia. Preliminary results showed a notable reduction in POD and increased awareness among anaesthesia team members regarding PROMs. The SBI approach demonstrated significant benefits during emergency situations, such as the February 2023 earthquake in Turkey, by providing crucial support and comfort to victims requiring multiple surgical interventions. The SBI presents an innovative, cost-effective, and patient-centred approach to perioperative care. By integrating PROMs and systematic feedback mechanisms, the SBI aims to expedite the advancement of efficient, patient-centered precision perioperative care, improve patient outcomes, and elevate the quality of care. The initiative has shown promising results, and its adoption is growing globally. Collaboration among healthcare providers, researchers, and patients is crucial in shaping the future of anaesthesia practice and further improving patient outcomes. Turkish hospitals are encouraged to join the SBI to benefit from international collaborations and contribute to positive change in perioperative care standards. The SBI project significantly advances precision anaesthesia, emphasising personalised care and patient well-being

Maintenance of balance between airway pressure and intracranial pressure in a patient with tracheal stenosis undergoing craniotomy: a case report

Background and objectives: Tracheal stenosis is a rare but a life-threatening condition and anesthesia of a patient with tracheal stenosis is challenging for anesthesiologists. Maintaining stable hemodynamics and ventilation parameters are important issues in neuroanesthesia. Any increase in airway peak pressure and ETCO2 will result in increase in intracranial pressure which must be avoided during craniotomies. Tracheal stenosis could be a reason for increased airway pressure. Case report: We described a patient undergoing craniotomy with tracheal stenosis. Conclusion: Detailed preparation for intubation, to stabilize airway dynamics and to make the right decision for the surgery were important points. To maintain of a good balance between cerebral dynamics and airway dynamics were the pearls of this case. Resumo: Justificativa e objetivos: Estenose traqueal é uma doença rara, mas de risco, e a anestesia em paciente com estenose traqueal é um desafio para os anestesiologistas. Manter os parâmetros hemodinâmicos estáveis e a ventilação são questões importantes em neuroanestesia. Qualquer aumento da pressão de pico das vias aéreas e da ETCO2 resultará em aumento da pressão intracraniana, o que deve ser evitado durante craniotomias. A estenose traqueal pode ser uma razão para o aumento da pressão das vias aéreas. Relato de caso: Descrevemos o caso de um paciente submetido à craniotomia com estenose traqueal. Conclusão: A preparação detalhada para a intubação, estabilizar a dinâmica das vias aéreas e tomar a decisão certa para a cirurgia foram pontos importantes. Manter um bom equilíbrio entre a dinâmica cerebral e a dinâmica das vias aéreas foi a pérola deste caso. Keywords: Craniotomy, Tracheal stenosis, Intracranial pressure, Palavras-chave: Craniotomia, Estenose traqueal, Pressão intracranian

Maintenance of balance between airway pressure and intracranial pressure in a patient with tracheal stenosis undergoing craniotomy: a case report

Abstract Background and objectives: Tracheal stenosis is a rare but a life-threatening condition and anesthesia of a patient with tracheal stenosis is challenging for anesthesiologists. Maintaining stable hemodynamics and ventilation parameters are important issues in neuroanesthesia. Any increase in airway peak pressure and ETCO2 will result in increase in intracranial pressure which must be avoided during craniotomies. Tracheal stenosis could be a reason for increased airway pressure. Case report: We described a patient undergoing craniotomy with tracheal stenosis. Conclusion: Detailed preparation for intubation, to stabilize airway dynamics and to make the right decision for the surgery were important points. To maintain of a good balance between cerebral dynamics and airway dynamics were the pearls of this case

Challenges of Obstetric Anesthesia: Difficult Laryngeal Visualization

Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient

What About Compressing the Oesophagus with an Ultrasound Probe for a Modified Sellick Maneuver?

Objective: Debates continue about the cricoid pressure, which has been used for many years to prevent gastric aspiration during intubation. Using ultrasound, the effects of this maneuver and alternatives like paralaryngeal pressure are revealed. The aim of this observational study was to determine the effect of paralaryngeal pressure with an ultrasound probe on the oesophageal diameter in patients with different body mass indexes and neck circumferences

WHAT ABOUT COMPRESSING THE OESOPHAGUS WITH AN ULTRASOUND PROBE FOR A MODIFIED SELLICK MANOEUVRE?

OBJECTIVE: Debates continue about the cricoid pressure, which has been used for many years to prevent gastric aspiration during intubation. Using ultrasound, the effects of this maneuver and alternatives like paralaryngeal pressure are revealed. The aim of this observational study was to determine the effect of paralaryngeal pressure with an ultrasound probe on the oesophageal diameter in patients with different body mass indexes and neck circumferences. METHODS: After measuring the neck circumference at the level of the cricoid cartilage, the oesophagus was visualized by ultrasonography. Compression was applied medially at a 45° angle toward the vertebral column by the ultrasound probe and oesophageal anteroposterior outer diameters were measured. Correlations between body mass index, neck circumference, oesophageal diameter, and oesophageal diameter change ratio were evaluated with Pearson’s r value. RESULTS: One hundred ten volunteers (52 women and 58 men) with mean age 33.7 ± 8.02 years and mean body mass index 25.6 ± 4.65 kg m(−2) were recruited. The oesophagus was located 78.18% partially to the left, 4.54% completely to the left, 1.81% to the right of the cricoid ring. In 15.45%, oesophagus could not be displayed. The mean diameter of the oesophagus was 7.6 ± 1.1 mm before pressure and 5.6 ± 0.09 mm after pressure (P .05). However, weak correlation was found between diameter change percentage and neck circumference (r = −0.33; P = .016). CONCLUSIONS: Paralaryngeal pressure with an ultrasound probe has the potential to occlude the oesophagus and may be effective in all patient groups