Comparison of three video laryngoscopy devices to direct laryngoscopy for intubating obese patients: a randomized controlled trial

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Electrographic lead I and V5 monitoring could have detected a missed left‐side pneumothorax intraoperatively

Abstract We present an EKG monitoring strategy to detect pneumothorax during high‐risk surgery. In the literature, EKG changes and pneumothorax are well‐described. However, anesthesiologists only monitor lead II on a three‐lead EKG system in the operating room. In our case, there was only a subtle change in lead II for a left‐sided pneumothorax, which could have been easily missed. On the contrary, there was a marked QRS amplitude reduction and T wave flattening/inversion in lead I and V5. We recommend lead V5 be added to the continuous monitoring and lead I be periodically checked for surgeries known to potentially cause pneumothorax

Effect of intraoperative or postoperative intravenous acetaminophen on postoperative pain scores and opioid requirements in abdominal and spinal surgery patients

Acetaminophen is a commonly used non-opioid analgesic with a well-established safety and tolerability profile. This retrospective study investigated the effects of intraoperative vs postoperative administration of intravenous (IV) acetaminophen on opioid consumption and pain scores in surgical patients. We included 147 patients who underwent abdominal or orthopedic spinal surgery who met all inclusion criteria; 41 patients received IV acetaminophen intraoperatively, 52 patients received it postoperatively and 54 control patients who did not receive IV acetaminophen. Patient outcomes were measured through 24-hour Visual Analog Scale (VAS) for pain scores, 24-hour opioid consumption, post-anesthesia care unit (PACU) pain scores, PACU and hospital length of stay and the time to first ambulation. The patients in the intraoperative IV acetaminophen group had a) significantly decreased 24-hour average pain scores (4.3±1.7) compared to the postoperative IV acetaminophen group (6.3±1.5) and to the control group (5.3±1.5) (p\u3c0.05), b) decreased 24-hour opioid consumption (102±168) compared to the control group (189±153) (p\u3c0.001), and c) had lower PACU initial pain scores (4±3.5) compared to the control group (6±4) (p\u3c0.05). Also, the patients in the intraoperative IV acetaminophen group had reduced length of hospital stay (4.2±3.2) when compared with those in the control group (5.6±3.3) (p\u3c0.05). Intraoperative IV acetaminophen significantly reduced the intraoperative opioid requirements compared to the controls (54±97 vs 119±149) (p\u3c0.05). Intraoperative IV acetaminophen administration as an adjunct analgesic decreased postoperative opioid requirements and enhanced analgesia

A novel visual facial anxiety scale for assessing preoperative anxiety.

BACKGROUND:There is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS) for assessing acute preoperative anxiety. METHODS:The initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1). After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses) were recruited to participate in this study. The participants were asked to: (1) rank the 11 faces from 0-10 (0 = no anxiety, while 10 = highest anxiety) and then to (2) match one of the 11 facial expression with a numeric verbal rating scale (NVRS) (0 = no anxiety and 10 = highest level of anxiety) and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale. RESULTS:The highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2). For the six categorical anxiety levels, a total of 260 (98.1%) participants chose the face A0 as representing 'no' anxiety, 250 (94.3%) participants chose the face A10 as representing 'highest' anxiety and 147 (55.5%) participants chose the face A8 as representing 'moderate-high' anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58), but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%)(Fig 3). Similarly, the correlation of the faces A7 and A6 was significantly correlated with moderate anxiety (r = 0.87), but A7 remained because of its higher frequency (35.9% vs 22.6%). Using frequency and Spearman correlations, the final order of the faces assigned to the categories none, mild, mild-moderate, moderate, moderate-high and highest anxiety levels was A0, A1, A5, A7, A8 and A10, respectively (Fig 4). CONCLUSION:The proposed VFAS was a valid tool for assessing the severity of acute [state] anxiety, and could be easy to administer in routine clinical practice

Use of herbal medication in the perioperative period: Potential adverse drug interactions

Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period

The highest frequencies of the 11 facial expressions.

<p>The highest frequencies of the 11 facial expressions.</p

A total of 11 facial expressions were designed to reflect differing levels of stressfulness.

<p>A total of 11 facial expressions were designed to reflect differing levels of stressfulness.</p

The proposed Visual Facial Anxiety Scale (VFAS).

<p>The proposed Visual Facial Anxiety Scale (VFAS).</p

Assessment of myocardial reactivity to controlled hypercapnia with free-breathing T2-prepared cardiac blood oxygen level–dependent MR imaging

Purpose: To examine whether controlled and tolerable levels of hypercapnia may be an alternative to adenosine, a routinely used coronary vasodilator, in healthy human subjects and animals. Materials and Methods: Human studies were approved by the institutional review board and were HIPAA compliant. Eighteen subjects had end-tidal partial pressure of carbon dioxide (PetCO2) increased by 10 mm Hg, and myocardial perfusion was monitored with myocardial blood oxygen level–dependent (BOLD) magnetic resonance (MR) imaging. Animal studies were approved by the institutional animal care and use committee. Anesthetized canines with (n = 7) and without (n = 7) induced stenosis of the left anterior descending artery (LAD) underwent vasodilator challenges with hypercapnia and adenosine. LAD coronary blood flow velocity and free-breathing myocardial BOLD MR responses were measured at each intervention. Appropriate statistical tests were performed to evaluate measured quantitative changes in all parameters of interest in response to changes in partial pressure of carbon dioxide. Results: Changes in myocardial BOLD MR signal were equivalent to reported changes with adenosine (11.2% ± 10.6 [hypercapnia, 10 mm Hg] vs 12% ± 12.3 [adenosine]; P = .75). In intact canines, there was a sigmoidal relationship between BOLD MR response and PetCO2 with most of the response occurring over a 10 mm Hg span. BOLD MR (17% ± 14 [hypercapnia] vs 14% ± 24 [adenosine]; P = .80) and coronary blood flow velocity (21% ± 16 [hypercapnia] vs 26% ± 27 [adenosine]; P > .99) responses were similar to that of adenosine infusion. BOLD MR signal changes in canines with LAD stenosis during hypercapnia and adenosine infusion were not different (1% ± 4 [hypercapnia] vs 6% ± 4 [adenosine]; P = .12). Conclusion: Free-breathing T2-prepared myocardial BOLD MR imaging showed that hypercapnia of 10 mm Hg may provide a cardiac hyperemic stimulus similar to adenosine