Airway Management during Pregnancy and Labor

Pregnant women undergo non-obstetric surgeries as well as cesarean operations. Airway management can be complicated due to physiological changes which occur in the respiratory system of labors. The most common causes of pregnancy-specific hypoxic respiratory failure are eclampsia, preeclampsia, and pulmonary edema that develops secondary to tocolytics. Approximately 10–15% of pregnant women undergo emergency cesarean section. Regional anesthesia is a preferred technique worldwide most commonly, and general anesthesia is applied with rapid sequence induction for the rest of the patients. Difficult Airway Society Master Algorithm for Obstetric Patients is a useful method to manage the airway in labors

Airway Management in Accident and Emergency

Accidents are associated with airway complications. Tracheobronchial injury, pneumothorax, pneumomediastinum, atelectasis, and subcutaneous emphysema can be observed. Therefore airway management in emergency medicine requires skills and equipment. Rapid-sequence intubation, effective preoxygenation, apneic oxygenation, manual inline stabilization technique should be used properly. Rapid-sequence intubation consists of sedation, analgesia, and muscle paralysis components. Videolaryngoscopes, supraglottic and extraglottic airway devices, bougie and surgical airway tools are among training materials. A range of training materials have been described to improve providers’ understanding and knowledge of patient safety. In conclusion providing oxygenation, minimizing the risk of complications and choosing the appropriate devices constitute the airway management’s pearls

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

Volatile agents and renal transplantation

Living donor and cadaveric donor renal transplantation have received a significant interest. During the procedure, both volatile agents and total intravenous anesthesia are used.&nbsp; However, the effects of volatile agents used during anesthesia on primary graft dysfunction is controversial. Besides evidence-based scientific data is not enough to conclude the ideal inhalation agent in renal transplantation. This review aimed to determine the effects of volatile agents preventing or improving the Ischemia Reperfusion (IR) injury during general anesthesia in patients undergoing renal transplantation. The possible mechanisms that affect the outcome of the patients after transplantation will be discussed.</p

Basic airway equipments in pediatric cardiac arrest management

WOS: 000381693300012In both in-hospital and out-of-hospital settings, pediatric cardiac arrest cases are common. Performing rescue breathing within a shorter time and achieving safe airway as early as possible during resuscitation is important for reducing interruptions. After a thorough review of the literature we concluded that the number of available randomized clinical studies is not enough to prove the superiority of different airway equipments in pediatric cardiac arrests. It is clear that the steps to be taken in this field will help determine the superior methods and create a tremendous impression. There is no data supporting the routine use of any of these airway equipments. The most appropriate technique depends on the conditions of cardiac arrest and experience of the practitioner. Supraglottic airway equipments, which have been developed for pediatric airway management, seems to be convenient in airway management. However pediatric tracheal intubation requires training and experience, thus presents a high incidence of complications. (C) 2016 Elsevier Ltd. All rights reserved

Risk assessment and anesthesia management in children with congenital heart disease undergoing non-cardiac surgery

The prevalence of congenital heart disease is about 8 to 10 case per 1000 live births and is a major cause of increased mortality and morbidity in pediatric patients undergoing noncardiac surgery. Therefore safe anesthesia and adequate recovery should be provided. It is important to determine the patient’s risk score in the preoperative period. However, the risk assessment tools have a limited prediction for increased mortality and morbidity of non-cardiac surgery. The most important point in determining the anesthesia method is to be aware of the latest situation both anatomically and physically about the circulation of patient and to create the specific planning. In these patients, the aim of maintenance of anesthesia is to increase arterial oxygen saturation by increasing pulmonary blood flow. Thus the use of appropriate anesthesia and monitoring methods through multidisciplinary decision-making and planning, as well as the identification of high-risk patients based on risk classification, may reduce mortality and morbidity in the pediatric patients with congenital heart disease.</p

Does Transfusion of Blood and Blood Products Increase the Length of Stay in Hospital?

WOS: 000474767900017PubMed ID: 30988569We aimed to analyze the use of blood products in cardiac surgery and to investigate its effect on clinical outcomes. Perioperative transfusion requirement, survival and complication rates and the duration of hospitalization were noted. Patients were divided into two groups considering the duration of hospital and intensive care unit (ICU) stay. The cardiopulmonary bypass time and the cross clamp time, and the amount of used cryoprecipitate, fresh frozen plasma, platelet, red blood cell and the bleeding amount were significantly higher in groups that stayed at the hospital for >7days and at the ICU for >2days (p>0.05). In the univariate model, to predict the patients who might stay at the hospital for more than 1week and who might stay at the ICU for more than 3days, we considered the significant efficacy of postoperative blood transfusion, bleeding amount, and the cardiopulmonary bypass time (p<0.05). In the reduced multivariate model, however, we analyzed the significant-independent efficacy of the postoperative fresh frozen plasma use to determine the patients who would stay at the hospital for more than 1week and who would stay at the ICU for more than 3days (p<0.05). We have concluded that increased use of blood products was associated with the cross clamp and cardiopulmonary bypass time and prolonged duration of hospital and ICU stays. In open cardiac surgeries, the use of blood products due to bleeding was identified as a predictor for staying longer than 3days at the ICU and longer than 7days at the hospital