Causes of suboptimal preoxygenation before tracheal intubation in elective and emergency abdominal surgery

Optimal preoxygenation (PO) prior to tracheal intubation reduces the risk of arterial desaturationand prolongs the period of safe apnoea. The common methods of PO are mask ventilation with100% O2for 3–5 minutes or, alternatively, asking the patient to take eight deep breaths in aminute. Our study group conducted a prospective study to assess the impact of the most com-mon risk factors on PO and to compare the efficiency of PO in patients undergoing elective andemergency abdominal surgery without premedication. PO was performed using mask ventilationwith 6 l/min of 100% oxygen for 5 minutes. End-tidal oxygen (EtO2) was documented in 30-second increments. We found that optimal PO (EtO2> 90%) was not achieved by almost half ofthe patients (46%) and that this was more common in the elective surgery group. Effective POwas not impacted by any of the evaluated risk factors for suboptimal oxygenation. Despite thesefindings, we believe that the identification of potential risk factors is crucial in the pre-anaesthesiastage, given the benefits of optimal PO

Sevoflurane and desflurane effects on early cognitive function after low‐risk surgery: A randomized clinical trial

Background and objectives: Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study,we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. Materials and methods: Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia,were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. Results: Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (–2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlatedwith total postoperative score (r = –0.35, p = .007). Conclusions: Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance

Are We Meeting the Current Standards of Consent for Anesthesia? An International Survey of Clinical Practice

ACKGROUND International application of existing guidelines and recommendations on anesthesia-specific informed consent is limited by differences in healthcare and legal systems. Understanding national and regional variations is necessary to determine future guidelines. MATERIAL AND METHODS Anonymous paper surveys on their practices regarding anesthesia-specific patient informed consent were sent to anesthesiologists in Estonia, Latvia, and Lithuania. RESULTS A total of 233 responses were received, representing 36%, 26%, and 24% of the practicing anesthesiologists in Lithuania, Latvia, and Estonia, respectively. Although 85% of responders in Lithuania reported using separate forms to secure patient informed consent for anesthesia, 54.5% of responders in Estonia and 50% in Latvia reported using joint forms to secure patient informed consent for surgery and anesthesia. Incident rates were understated by 14.2% of responders and overstated by 66.4% (P<0.001), with the latter frequently quoting incident rates that are several to tens of times higher than those published internationally. Physicians obtaining consent in the outpatient setting were more satisfied with the process than those obtaining consent on the day of surgery, with 62.5% and 42.6%, respectively, agreeing that the informed consent forms provided a satisfactory description of complications (P=0.03). Patients were significantly less likely to read consent information when signing forms on the day of surgery than at earlier times (8.5% vs. 67.5%, P<0.001). Only 46.2% of respondents felt legally protected by the current consent process. CONCLUSIONS Anesthesia-specific informed patient consent practices differ significantly in the 3 Baltic states, with these practices often falling short of legal requirements. Efforts should be made to improving information accuracy, patient autonomy, and compliance with existing legal standards