Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have immediate access ...to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management.
An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021.
Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use.
Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Endotracheal intubation is an airway management procedure commonly performed under general anesthesia. It is linked with postoperative voice changes. The incidence and reasons of hoarseness and vocal ...cord injury are not very well investigated, especially after short-term anesthesia and intubation in head and neck surgery. The aim of the study is to identify the causes of voice changes after short endotracheal anesthesia in head and neck surgery. The study will include patients scheduled for head and neck surgery under general anesthesia with endotracheal intubation up to 3 hours. There will be 3 groups of patients, as follows: thyroid surgery, non-thyroid surgery, and control group undergoing surgery outside head and neck. Videostroboscopy will be recorded before and after surgery. Further diagnostic workup will include voice status; subjective voice self-analysis; perceptive and objective acoustic voice analysis at 4 time points (preoperatively, postoperative day 2, 2 weeks and 1 month after surgery). Endotracheal intubation is a safe method of airway management although it can temporarily alter a patient's voice quality. It is not known how much of this is the result of anesthesia, general condition of the patient, or surgery. This trial is expected to shed some light on this issue.
Well-differentiated cancers, both papillary and follicular, account for 90% of all diagnosed thyroid cancers. They have an indolent disease course with a 20-year disease-specific survival over 90%. ...According to current guidelines, the therapy of choice for well-differentiated thyroid carcinoma is total thyroidectomy or lobectomy. The indication for prophylactic central neck dissection is still a controversial issue and the subject of unfinished and ongoing debate. There is no indication for prophylactic central neck dissection in follicular thyroid carcinomas, which primarily metastasize hematogenously. In small solitary papillary thyroid carcinomas (T1 and T2), prophylactic central neck dissection is not indicated as it does not bring benefits in terms of improved patient survival and at the same time significantly increases the risk of temporary and permanent postoperative complications. Prophylactic central neck dissection is indicated in advanced papillary thyroid cancers (T3 and T4) and all other high-risk well-differentiated thyroid cancer, as well as in the presence of metastatic lymph nodes in the lateral neck.
Adenoidectomy with or without tonsillectomy remains one of the most routinely performed surgical procedures in children. The duration of the procedure is usually less than half an hour and is done in ...a day surgery setting. Airway management for adenoidectomy can be especially challenging as the airway is shared between the surgeon and the anesthesiologist. The gold standard for airway management is an endotracheal tube (ETT), even though there has been an increase in the use of laryngeal mask airway (LMA) over the past decade. This retrospective study investigated patient data collected over a 4-year period (2016 to 2020). Data included 210 cases in a day surgery setting. We analyzed the choice of airway device and use of neuromuscular blockers and analgesics for pain management. The use of LMA was noted in 67.62% while endotracheal intubation was performed in 32.38% of cases. LMA resulted in fewer respiratory complications compared to ETT (p=0.006). The need for neuromuscular blockers was also lower in the LMA group (p=0.01). There was no statistically significant difference in the intraoperative dose of opioid analgesia (p=0.09). Flexible LMA is a satisfactory alternative to endotracheal intubation for outpatient pediatric adenoidectomy.
Central venous catheterization (CVC) of the internal jugular vein is an invasive procedure commonly performed in anesthesiology practice. Usually it is an uneventful procedure but complications such ...as bleeding, infection, and potential damage to the surrounding structures can occur. One of the complications is neck hematoma, which can distort airway anatomy and cause upper airway obstruction. We present a patient who underwent endovascular mitral valve repairment procedure under general anesthesia. Accidental puncture of carotid artery occurred while attempting to place the central line. Later, during awakening in the coronary intensive care unit, the patient developed neck hematoma. The diagnosis was confirmed with multi-slice computed tomography (MSCT) and MSCT angiography showed active arterial blood extravasation. Despite it, the patient was extubated. Awake tracheal intubation (ATI) with video laryngoscopy was the technique of choice for reintubation because of the neck swelling and compression onto laryngeal structures. In this case, rushed extubation put the patient at risk. Video laryngoscopy ATI with appropriate preparation and titrated sedation can enable quick and safe rescue airway management in patients with rapidly developing neck hematoma, along with definitive evacuation and treatment.
SAŽETAK
U gotovo 50 godina od prve primjene, izvantjelesna potpora cirkulaciji postala je nezamjenjivim alatom u zbrinjavanju djece i odraslih s teškim zatajenjem srca i pluća refraktornim na ...konzervativno liječenje. Tijekom posljednjeg desetljeća prati se značajan porast primjene uređaja za izvantjelesnu membransku oksigenaciju u bolesnika svih dobnih skupina. Veća dostupnost uređaja i poboljšanje tehnologije doveli su do proširenja indikacija za njegovo korištenje. Bolesnik na izvantjelesnoj potpori cirkulaciji može biti podvrgnut hitnom kirurškom zahvatu ili dijagnostičko-terapijskim postupcima koji zahtijevaju prisutnost anesteziologa. Zbog protrombotskih svojstava uređaja, najveći klinički izazov jest pravilno titrirati lijekove za antikoagulaciju kako bi se komplikacije svele na najmanju razinu. Rizik od krvarenja i dalje je ograničavajući čimbenik za široku primjenu izvantjelesne potpore cirkulaciji. U ovom prikazu slučaja opisan je anesteziološki pristup mladiću priključenom na uređaj za izvantjelesnu membransku oksigenaciju, u kojega je bila indicirana žurna selektivna disekcija vrata. Cilj ovog rada jest uz primjer dati sažeti prikaz trenutnih spoznaja i preporuka za zbrinjavanje bolesnika anesteziolozima koji se u svojoj praksi rutinski ne susreću s uređajem za izvantjelesnu membransku oksigenaciju.
Transplantacija pluća terapija je izbora u bolesnika s posljednjim stadijem plućne insuficijencije uzrokovane najčešće kroničnom bolesti pluća, idiopatskom plućnom fibrozom ili cističnom fibrozom. ...Stopa preživljenja bolesnika s transplantiranim plućima posljednjih je godina u porastu, kao i potreba za kirurškim intervencijama i anestezijom u tih bolesnika, i to zbog različitih stanja od kojih su najčešća intraabdominalna. Anesteziološki pristup sjedinjuje poznavanje zdravstvenog stanja bolesnika i nuspojava imunosupresivne terapije te fiziologiju i patofiziologiju transplantiranih pluća kako bi odabir anesteziološke tehnike, a time i liječenja bolesnika s transplantiranim plućima imao što povoljniji ishod. Prikazujemo bolesnika koji je nakon obostrane transplantacije pluća podvrgnut općoj anesteziji radi operacije nediferenciranog karcinoma nosa, a kako bismo približili anesteziološke postupke u ove vulnerabilne skupine bolesnika.
Od prve transplantacije srca 1967. u svijetu se na godinu izvede oko 3500 novih transplantacija srca, uz prosječno posttransplantacijsko preživljenje od 15 godina. Danas je sve češće da skupina ...pacijenata s transplantiranim srcem bude podvrgnuta nekardijalnim operacijama, što je novi izazov za anesteziološko zbrinjavanje zbog patofizioloških i farmakoloških interakcija s denerviranim presatkom srca, nuspojava imunosupresivne terapije, rizika od infekcije i odbacivanja transplantata. U ovom prikazu pacijentici s transplantiranim srcem potpuno
je uklonjena štitnjača (tiroidektomija) zbog papilarnog karcinoma štitnjače. Pacijentica je bila I. kategorije prema klasifikaciji NYHA-e (New York Heart Association) i III. kategorije prema klasifikaciji ASA-e (American Society of Anesthesiologists), uz urednu funkciju alopresatka i stabilan sinusni ritam. Zahvat je izveden u općoj endotrahealnoj anesteziji. Neuromuskularni blok prekinut je sugamadeksom (Bridion®, Merck) i bolesnica je otpuštena kući nakon 3 dana.
Osmogodišnji dječak naručen je na elektivnu tonzilektomiju zbog ponavljanih upala srednjeg uha uzrokovanih hipertrofijom adenoida. Pacijent je imao otvoreni, tj. perzistentni arterijski duktus (engl. ...Persistent ductus arteriosus – PDA), čestu prirođenu srčanu grešku s očuvanom komunikacijom između aorte i plućne arterije. Kod pacijenta je postojao samo hemodinamski neznatan lijevo-desni pretok. Trenutačne smjernice za anesteziju pacijenata s lijevo-desnim pretokom uključuju: 1. održavanje ili smanjenje sustavnoga vaskularnog otpora
(SVR) kao hemodinamski cilj; 2. izbjegavanje smanjenja plućnoga vaskularnog otpora (PVR); 3.izbjegavanje hiperoksije i hipokarbije. Predoperacijska obrada uključivala je suradnju s pedijatrijskim kardiologom koji je napravio procjenu pacijentova srčanog statusa, uključujući ultrazvuk srca i elektrokardiogram (EKG). Tijek anestezije
protekao je bez neželjenih događaja. Nakon reverzije neuromuskularne blokade i ekstubacije pacijent je budan, hemodinamski stabilan i zadovoljavajućega respiratornog stanja prebačen u sobu za oporavak poslije anestezije. Preoksigenacija 100%-tnim kisikom prijeporna je u ovakvih pacijenata. Detaljna predoperacijska procjena srčanog
statusa i izbjegavanje povećanja protoka kroz otvorenu komunikaciju ključni su za dobar ishod u pacijenata s PDA-om.
Termin otežani dišni put odnosi se na teškoće pri intubaciji i ekstubaciji. U ovom radu prikazujemo otežanu ekstubaciju i postupak zbrinjavanja dišnog puta u bolesnice nakon učinjene parotidektomije. ...Iako postoje smjernice za otežani dišni put, ne postoje jasne upute za mehanički uzrokovanu otežanu ekstubaciju kada se endotrahealni tubus ne može izvaditi. Takva stanja rijetko se spominju u literaturi, obično u obliku prikaza bolesnika. Nemogućnost vađenja endotrahealnog tubusa zbog mehaničkih uzroka hitno je stanje, stoga nalaže izradu smjernica i algoritma postupanja. Algoritam koji smo rabili u ovom slučaju protekao je bez komplikacija i bolesnica se dobro oporavila.
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