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

Dopamine - a Preventive Agent for Mesenteric Ischemia and Reperfusion Injury in Abdominal Compartment Syndrome

Objectives. Acutely increased intra-abdominal pressure (IAP) may lead to abdominal compartment syndrome (ACS) and multiple organ failure. In a prospective randomized way, the effect of dopamine infusion (3 mu g/kg/min) on mesenteric perfusion, cytokine levels and intestinal histopathological changes were studied in the presence of ACS. Material and Methods. The study involved 28 male Sprague Dawley rats randomly assigned to four groups (n = 7). The external jugular vein was cannulated for infusions. In group 1, before increasing IAP, a 60-minute infusion of dopamine was performed; following this, IAP was raised and the dopamine infusion was continued for another 60 minutes. In group 2 an IAP of 20 mm Hg was maintained for 60 minutes by air insufflation. In group 3, a dopamine infusion was performed simultaneously with an IAP of 20 mm Hg for 60 minutes. Group 4 was the control. Following this phase, midline laparatomy and superior mesenteric artery (SMA) dissection was carried out in all groups and SMA perfusion was measured continuously for 30 minutes with a Doppler probe. Myeloperoxidase (MPO) activity, lipid peroxidation and glutathione (GSH) levels were measured in tissue samples and histopathological scoring was carried out. Results. The results demonstrated that SMA blood flow was increased in Group 1 and Group 3 (100.77 +/- 2.94 and 93.82 +/- 4.91 mm Hg, respectively) but decreased significantly in Group 2 (74.23 +/- 3.01 mm Hg; p < 0.01). Intestinal tissue malondialdehyde (MDA) levels (24.03 +/- 2.75 nmol/g) and MPO activity (260.5 +/- 11 u/g) were elevated in Group 2; histological scores were elevated in all groups (p < 0.05); and GSH levels were reduced in Group 2 (0.58 +/- 0.24 mu mol/g; p < 0.01). Conclusions. The results indicated that high IAP causes oxidative organ damage and that dopamine may lessen reperfusion-induced oxidative damage by reducing splanchnic perfusion and controlling the reperfusion of the intra-abdominal organs (Adv Clin Exp Med 2011, 20, 5, 613-621)

The Effects of Preoperative Oral Pregabalin and Perioperative Intravenous Lidocaine Infusion on Postoperative Morphine Requirement in Patients Undergoing Laparatomy

OBJECTIVES: To evaluate and compare the effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement, adverse effects, patients’ satisfaction, mobilization, time to first defecation and time to discharge in patients undergoing laparotomy

Statistical analysis of associated vertebra and costal anomalies in spina bifida patients

Objective: Spina bifida is one of the most severe birth defects and can happen as a result of disrupted primary neurulation. Congenital vertebra and costa anomalies are more frequently seen with spina bifida, and associated anomalies significantly affect the prognosis of affected children. In this study, we aimed to determine the incidence of scoliosis, costal anomalies, and vertebral deformations seen at the time of diagnosis and to statistically evaluate their concomitancies. Methods: Gender and mean ages of the patients were determined. The spina bifida patients were examined for deformation anomalies, butterfly vertebra, hemivertebra, wedge vertebra, costal anomalies and scoliosis. The relationships between these anomalies were evaluated. Results: 94 patients with a mean age of 11,5 months examined. The incidence of scoliosis was 21.8% among female infants and 17.9% among males. Rates of scoliosis with vertebra anomalies (hemivertebra, wedge vertebra) and costal anomalies did not differ significantly (P &gt; 0.05). Wedge vertebra were the most frequent vertebra anomaly type with 38.2% ratio. Costal anomalies were detected in 25.5% of females and 20.5% of male infants. Hemivertebra and wedge vertebra were seen significantly more frequently in this group. Gender distribution did not differ between with and without any vertebra types. Conclusion: Congenital vertebra and costa anomalies are more frequently seen with spina bifida. We believe that these anomalies and relationship with spina bifida may demonstrate differences among different ethnic groups or locations. More detailed multi-centered studies performed on this issue will aid in the determination of etiologies, genetics, and treatment principles of these congenital anomalies

Comparison of postoperative pain in children after maintenance anaesthesia with propofol or sevoflurane: a systematic review and meta-analysis.

Propofol and sevoflurane are two of the most commonly used anaesthetics for paediatric surgery. Data from some clinical trials suggest that postoperative pain incidence is lower when propofol is used for maintenance of anaesthesia compared with sevoflurane, although this is not clear. This meta-analysis compared postoperative pain following maintenance of anaesthesia with propofol or sevoflurane in paediatric surgeries. PubMed Medline, Embase, Scopus, Web of Science and Cochrane Library were searched for randomised controlled trials (RCTs) that compared postoperative pain between sevoflurane and propofol anaesthesia in children. After quality assessment, a meta-analysis was carried out using bias-adjusted inverse heterogeneity methods, heterogeneity using I and publication bias using Doi plots. In total, 13 RCTs with 1174 children were included. The overall synthesis suggested nearly two-fold higher odds of overall postoperative pain in the sevoflurane group compared with the propofol group (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.12-3.15, I=58.2%). Further, children in the sevoflurane group had higher odds of having higher pain scores (OR 3.18, 95% CI 1.83-5.53, I=20.9%), and a 60% increase in the odds of requiring postoperative rescue analgesia compared with propofol (OR 1.60, 95% CI 0.89-2.88, I=58.2%). Children maintained on inhalational sevoflurane had higher odds of postoperative pain compared with those maintained on propofol. The results also suggest that sevoflurane is associated with higher odds of needing postoperative rescue analgesia compared with propofol. The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023445913.Open access funding provided by the Qatar National Library

Risk Factors of Difficult Intubation in Patients with Severe Obesity Undergoing Bariatric Surgery: A Retrospective Cohort Study

Background: Obesity poses significant challenges by altering upper airway anatomy and making mask ventilation and tracheal intubation difficult. In 2023, 46.1% women and 35.9% men &gt; 18 years were classified as obese in Qatar, yet intubation complications in this group have not been extensively studied. The aim of this study was to evaluate the frequency and types of intubation complications in adults with severe obesity undergoing bariatric surgery and to identify incidence of difficult intubation and associated risk factors. Methods: In this retrospective cohort study, 2421 patients (1664 females and 746 males) were analyzed. All patients with severe obesity aged over 18 years with a BMI of 40 kg/m2 or higher, who underwent bariatric surgery from January 2014 to January 2024, were included. Difficult intubation was defined as the need for video laryngoscopy, cricothyrotomy, intubation via a supraglottic airway device, use of a stylet or bougie, more than one intubation attempt, or desaturation during intubation. Results: None of the patients experienced any complications of interest. Video laryngoscope was used in 85 patients (3.5%), first-attempt intubation success rate was 95.4%, with more than one attempt required in 4.6% of cases. Logistic regression revealed that the odds of complicated intubation were 1.5 times higher in patients with a BMI &gt; 60, 8.9 times higher in those with Cormack-Lehane class IV, and 5.1 times higher in patients with Mallampati score of IV. Comorbidities increased the odds by 1.3 times, with asthmatic patients having 2.1-fold higher odds. Conclusion: This study highlights the challenges of tracheal intubation in patients with severe obesity undergoing bariatric surgery and the need for tailored strategies to manage these difficulties.Scopu

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries