Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Bilateral hypoglossal nerve paralysis following elongated styloid process resection: case report

We report a case of anesthetic management of a 43-year-old patient with Eagle's syndrome (ES) in whom post-extubation acute airway obstruction occurred due to bilateral hypoglossal nerve paralysis. After an accurate examination, elongated bilateral stylohyoid ligament was observed and surgical resection was planned. After completion of the surgery following extubation, significant dysfunction in swallowing, speech function, and tongue motion was observed. The clinical situation was evaluated as bilateral hypoglossal nerve paralysis related to the procedure. The patient was closely observed over 48 h in the intensive care unit. After 2 days, the patient was discharged to a surgical ward. Following clinical assessment, the patient was discharged from hospital for monthly return. At the 6-month follow-up, there were no further episodes of paresthesia and other symptoms. In conclusion, patients with ES represent a real challenge for physicians from diagnosis to treatment, especially regarding perioperative complications, and close collaboration between surgeons and anesthesiologists is of crucial importance

Airway Surgery in Tracheostomised Patients with Wegener Granulomatosis Leading to Subglottic Stenosis

Wegener granulomatosis (WG) is a multisystemic disorder characterised by granulomatous inflammation of the respiratory system. The growing of proliferative tissue towards the larynx and trachea may cause airway obstruction on account of subglottic stenosis. In this situation, the surgical goal is to eliminate the airway obstruction by providing natural airway anatomy. While mild lesions do not require surgical intervention, in fixed lesions, surgical intervention is required, such as tracheostomy, laser resection and dilatation. In tracheostomised patients, granuloma formation surrounding the tracheostomy cannula may occur in the trachea. Inflammation and newly formed granulation tissue result in severe stenosis in the airways. During surgical treatment of such patients, airway management is important. In this case report, we will discuss gas exchange and airway management with jet ventilation (JV) during excision of the granulation tissue with endolaryngeal laser surgery, leading to subglottic stenosis in tracheostomised patients in WG

Ultrasonographic Measurement of Subglottic Diameter for Paediatric Cuffed Endotracheal Tube Size Selection: Feasibility Report

Objective: The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size

Haemodynamic Response to Four Different Laryngoscopes

Objective: In this prospective randomized study, we aimed to evaluate the effect of tracheal intubation with four different laryngoscopes [Macintosh direct laryngoscope-classic laryngoscope (CL), McCoy (MC), C-Mac video-laryngoscope (CM) and McGrath video-laryngoscope (MG)] on haemodynamic responses in patients with a normal airway

The Evaluation of the Effects of Erythrocyte Transfusion on Central Venous Oximetry in Major Surgery Patients

Objective: Blood transfussion is generally performed to improve oxygen delivery (DO2). Transfusion decision is mostly based on hemoglobin levels, regardless of actual DO2 requirement. As central venous oxygen saturation (ScvO(2)) may reflect the imbalance between DO2 and consumption (VO2), the aim of this study was to investigate the effect of red blood cell transfusion on ScvO(2) levels in major surgery patients

A Rare Cause of Difficult Intubation: Fraser Syndrome

Fraser syndrome is a rarely encountered autosomal and recessive disease and is characterized with multiple anomalies. The laryngeal atresia or stenosis accompanying the disease may pose serious inspiratory distress. Stenosis of lesser rate may manifest itself as difficult or impossible intubation cases. In this text, a 1-year-old patient who posed a problems in intubation and required a follow-up surgical airway is presented

Comparison of sevoflurane and ketamine for anesthetic induction in children with congenital heart disease

Background: Sevoflurane is widely used in pediatric anesthesia for induction. Ketamine has been preferred in pediatric cardiovascular anesthesia. Aim of this study was to compare the hemodynamic effects and the speed of ketamine and sevoflurane for anesthesia induction in children with congenital heart disease

The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients.

Background: The aim of this prospective study was to investigate the success of ultrasound in pediatric patients in determining the appropriate sized cuffed endotracheal tube and to compare the results with conventional height-based (Broselow) tape and age-based formula tube size

Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy

Objective: Determining the blood flow through intra and extra-cranial arteries during neck extension may be helpful but is a controversial issue. We aimed to elucidate the changes in cerebral blood flow related to head positioning during thyroid surgery by carotid Doppler examination and regional oxygen saturation variations