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Low Dosage of Sugammadex Might Not Induce Laryngospasm

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Comparing Bupivacaine, Lidocaine, and a Combination of Bupivacaine and Lidocaine for Labor Epidural Activation: A Prospective, Randomized, Double-Blind Study

Objective: Epidural anesthesia for the parturient is often provided in a clinical context where rapid onset of segmental analgesia is important; however, little is published on the ideal local anesthetic to safely achieve this onset. To fill this gap in knowledge, we studied bupivacaine and lidocaine, two local anesthetics (LA) commonly used for labor epidural activation, either as a single drug or in combination to determine the onset of epidural analgesia. Methods: In this double-blinded study, seventy-five patients were randomized into three groups (n = 25 each) for labor epidural activation: 10 mL of 0.25% bupivacaine, 10 mL of 1% lidocaine, or 5 mL of 0.25% bupivacaine plus 5 mL of 1% lidocaine. Patients were assessed for the first 20 min after drug administration at 5-min intervals. Data collected included sensory level to pinprick, maternal blood pressure, vasopressor administration, and peak motor blockade. Results: Data were analyzed on 71 of 75 patients. Time to loss of sensation to pinprick at the T_(10) dermatome in the bupivacaine group was significantly longer than the lidocaine group (p = 0.006), but the time to loss of sensation to pinprick at the T_(10) dermatome did not significantly differ in the bupivacaine plus lidocaine group when compared to both the bupivacaine (p = 0.114) as well as the lidocaine (p = 0.203) groups. Phenylephrine usage did not significantly differ amongst the three groups (p = 0.062). Conclusion: Lidocaine provides statistically significant faster onset of epidural analgesia when compared to bupivacaine only. Combining the two LA did not significantly affect onset.

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A Defect Tunnel Induced Air Leakage in a Double-Lumen Tube

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Improvement in Neonatal Refractory Hypoxia by Airway Pressure Release Ventilation With a Cuffed Tube and Intracuff Pressure Monitoring

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Comparison of the Pulse Wave Transit Time Method and an Arterial Pressure-Based Cardiac Output System for Measuring Cardiac Output Trends During Laparotomy Without Postural Change

Objective: Perioperative intravascular volume can be optimised by identifying predictors of fluid responsiveness. This study compared the estimated continuous cardiac output (esCCO) system for noninvasive measurement and an arterial pressure-based cardiac output (APCO) system for detecting exact changes in cardiac output (CO) among patients undergoing laparotomy without postural change. Methods: This study was performed at Toho University Omori Medical Centre in Japan from April 2016 to July 2016 and included 26 adult patients undergoing elective laparotomy lasting ＞ 2 h without postural change. We evaluated both interchangeability and dynamic trend. After entering the biometric data (age, sex, height, weight, heart rate, pulse wave transit time, and blood pressure), the esCCO device was calibrated. All patients were also monitored with the APCO system. Data were analysed and compared for 12 adult patients using Bland-Altman analysis and polar plots. Results: The CO value obtained with esCCO was 0.75 ± 0.86 L/min (percentage error: 41%) lower than that obtained with the APCO system. Polar plotting revealed that the mean angular bias was 3.5°, and the radial limit of agreement was 28.3°. Conclusion: This study demonstrated that data obtained using esCCO are not interchangeable with those obtained using the APCO system. The trending ability of the esCCO device was deemed good among patients undergoing laparotomy without postural change.

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Validation of the Radford Nomogram to Estimate the Minute Volume Required to Attain Normocapnia in Patients Undergoing General Anesthesia: A Single-Center Retrospective Study

Objective: The Radford nomogram, an old mathematical chart device to estimate the required ventilation for maintaining normocapnia, remains unvalidated in patients undergoing modern, balanced anesthesia. This study aims to investigate the performance of the Radford nomogram in patients undergoing general anesthesia and derive a simple equation to estimate the minute volume required to attain normocapnia (MV_(norm)). Methods: This single-center retrospective study enrolled 78 patients (age ≥ 18 years) undergoing cerebral revascularization for Moyamoya disease. We defi ned MV_(norm) as the median of all values of the minute volume during normocapnia (estimated PaCO_2: 38-42 mmHg). We examined the agreement level between the estimated minute volume using the Radford nomogram and MV_(norm) using the Bland-Altman analysis. Furthermore, we developed and validated a simple equation predicting MV_(norm) based on gender and a multiple of body weight, using a split-sample validation technique. Results: The Radford nomogram tended to overestimate MV_(norm) with a mean bias of 560 mL/min (95% limits of agreement, -848-1,968 mL/min). The equation developed using data from the development group (n = 52): required minute volume (mL/min) = 85 × body weight (kg) in male patients and 70 × body weight (kg) in female patients. In the validation group (n = 26), the mean bias of this simple equation was 224 mL/min (95% limits of agreement, -1,264-1,712 mL/min). Conclusion: The Radford nomogram overestimates MV_(norm) in modern, balanced anesthesia. The simple equation using gender and a multiple of body weight yields similar predictive performance to the Radford nomogram.

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Remifentanil-Induced Transient Right Bundle Branch Block During Hemorrhoidectomy

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A novel Technique for Arterial Cannulation in Neonates: Angulation of Arterial Cannula

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Burnout in Anesthesiology and Perioperative Care Providers in Asia: Background and Context

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Factors Related to Delayed Extubation in Cervical Spine Surgery in an Academic Hospital: A Retrospective Study of 506 Patients

Objective: The incidence of airway obstruction has been reported to be 1.2-6.1% after cervical spine surgery and up to 27% in posterior occipito-cervical spinal fusion. Communication between the anesthesiologist, surgeon, and staff responsible for postoperative care, and the identification of patients at risk of airway complications are important. We aimed to determine the incidences of delayed extubation and reintubation, and the factors related to delayed extubation after cervical spine surgery. Methods: A review was conducted of the medical records of patients who underwent cervical spine surgery in the orthopedic and neurosurgery units, Siriraj Hospital, between January 2012 and May 2017. The data included demographics, perioperative airway management, postoperative airway complications (delayed extubation and reintubation), and outcomes. Results: Of the 506 patients analyzed, delayed extubation occurred in 116 (22.9%), and 15 (3.0%) were reintubated. The independent related factors for delayed extubation were blood loss ≥ 300 mL (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.33-5.49); intraoperative fluid administration ≥ 2,000 mL (OR, 2.17; 95% CI, 1.08-4.36); anesthetic time of ≥ 300 min (OR, 3.74; 95% CI, 1.83-7.63); and case finished after service hours (OR, 3.18; 95% CI, 1.73-5.88). Conclusion: The incidence of delayed extubation in cervical spine surgery patients was high, and reintubation was common. Anesthesiologists should be cognizant of the related risk factors before deciding between immediate or delayed extubation.