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Background: Reverse triggering (RT) was described in 2013 as a form of patient-ventilator asynchrony, where patient's respiratory effort follows mechanical insufflation. Diagnosis requires esophageal pressure (Pes) or diaphragmatic electrical activity (EAdi), but RT can also be diagnosed using standard ventilator waveforms. Hypothesis: We wondered (1) how frequently RT would be present but undetected in the figures from literature, especially before 2013; (2) whether it would be more prevalent in the era of small tidal volumes after 2000. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, from 1950 to 2017, with key words related to asynchrony to identify papers with figures including ventilator waveforms expected to display RT if present. Experts labelled waveforms. 'Definite' RT was identified when Pes or EAdi were in the tracing, and 'possible' RT when only flow and pressure waveforms were present. Expert assessment was compared to the author's descriptions of waveforms. Results: We found 65 appropriate papers published from 1977 to now, containing 181 ventilator waveforms. 21 cases of 'possible' RT and 25 cases of 'definite' RT were identified by the experts. 18.8% of waveforms prior to 2013 had evidence of RT. Most cases were published after 2000 (1 before vs. 45 after, p = 0.03). 54% of RT cases were attributed to different phenomena. A few cases of identified RT were already described prior to 2013 using different terminology (earliest in 1997). While RT cases attributed to different phenomena decreased after 2013, 60% of 'possible' RT remained missed. Conclusion: RT has been present in the literature as early as 1997, but most cases were found after the introduction of low tidal volume ventilation in 2000. Following 2013, the number of undetected cases decreased, but RT are still commonly missed. Reverse Triggering, A Missed Phenomenon in the Literature. Critical Care Canada Forum 2019 Abstracts. Can J Anesth/J Can Anesth 67 (Suppl 1), 1–162 (2020). https://doi-org.myaccess.library.utoronto.ca/https://doi.org/10.1007/s12630-019-01552-z. [ABSTRACT FROM AUTHOR]

Purpose: To further identify the effectiveness of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) for pre- and apneic oxygenation during the anesthesia induction by comparison to facemask ventilation (FMV) based on current available evidence. Methods: Medline, EMBASE, Web of Science, Cochrane Library and CNKI databases were searched from inception to December 22, 2023 for available randomized controlled trials (RCTs). Primary outcomes were PaO2 and PaCO2 after intubation and safe apnoea time. Secondary outcomes included the O2 desaturation, end expiratory carbon dioxide (EtCO2) and complications. The effect measures for continuous and categorical outcomes were separately the mean difference (MD) and relative risk (RR) with 95% confidence interval. Results: Twelve RCTs with 403 patients in the THRIVE group and 401 patients in th FMV group were included. Pooled results demonstrated that the PaO2 after intubation was significantly higher (MD = 82.90mmHg, 95% CI: 12.25~153.54mmHg, P = 0.02) and safe apnoea time (MD = 103.81s, 95% CI: 42.07~165.56s, P = 0.001) was longer in the THRIVE group. Besides, the incidence rate of O2 desaturation (RR = 0.28, 95% CI: 0.12–0.66, P = 0.004) and gastric insufflation (RR = 0.26, 95% CI: 0.13–0.49, P<0.001) was significantly lower in the THRIVE group. Conclusion: Based on current evidence, THRIVE manifested better effectiveness representing as improved oxygenation, prolonged safe apnoea time and decreased risk of complications compared to standard FMV in surgical patients. Therefore, THRIVE could be served as a novel and valuable oxygenation technology for patients during anesthesia induction. [ABSTRACT FROM AUTHOR]

Background: In this era of laparoscopic surgery, with the use of carbon dioxide insufflation in creating pneumoperitoneum for ease of trocar insertion and visualization of anatomy, it comes certain systemic changes in the patient due to the compression effect of the gas as well as resorption of it through peritoneum. Aims and Objectives: The aim of the study was to assess baseline standards of hepatic and renal functional status in pre-operative patients in comparison with post-operative patients undergoing laparoscopic cholecystectomy (LC). Materials and Methods: Cases were chosen among the persons who presented with chronic calculus cholecystitis to the surgical out-patient department of Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata. Pre-operative liver function tests (LFT) and renal function tests (RFT) values were recorded. Again, LFT and RFT values were evaluated on post-operative day 1 (POD1) and POD12. Results: Serum conjugated and unconjugated bilirubin, aspartate amino transaminase, alanine amino transaminase, urea, estimated glomerular filtration rate values increases immediate postoperatively on POD1 but returns to normal pre-operative levels on POD 12. Serum alkaline phosphatase, albumin, and creatinine values decrease on POD1 and return to normal pre-operative values in POD 12. Conclusion: Hepatic and renal function changes in the immediate post-operative period of 24 h following LC. This change is transient and returns to normal levels within POD 12. [ABSTRACT FROM AUTHOR]

High-flow nasal oxygen (HFNO) therapy is extensively used in critical care units for spontaneously breathing patients. Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) is a method of apnoeic oxygenation with continuous nasal delivery of warmed, humidified oxygen at high-flow rates up to 70L/min. THRIVE extends the apnoeic window before desaturation occurs so that tubeless anaesthesia is possible. The advent of THRIVE has had a monumental impact on anaesthetic practice, with a diverse range of clinical applications and it has been incorporated into difficult airway guidelines. THRIVE has many applications in otolaryngology and head and neck surgery. It is used as a pre-oxygenation tool during induction in both anticipated and unanticipated difficult airway scenarios and as a method of oxygenation for tubeless anaesthesia in elective laryngotracheal and hypopharyngeal surgeries and during emergence from anaesthesia. In this scoping review of the literature, we aim to provide an overview on the utility of THRIVE in otolaryngology, including the underlying physiologic principles, current indications and limitations, and its feasibility and safety in different surgical contexts and specific population groups. [ABSTRACT FROM AUTHOR]

Background: The present study is undertaken to compare the conventional modes of ventilation namely pressure controlled and volume controlled ventilation and their impact on the ventilatory and hemodynamic parameters. This will throw light on the fluctuations in pressure and volume in a specific altered physiological state - obesity with pneumoperitoneum and add to the knowledge of optimizing ventilatory parameters to permit adequate oxygenation and establish superiority amongst the plethora of modes. Objectives: To assess and compare pressure controlled ventilation and volume controlled ventilation in patients with BMI=25Kg/m2 undergoing laparoscopic cholecystectomy. Methods: A hospital based cross sectional comparative study was conducted in 42 overweight and obese patients of (18-60) years of either sex with ASA I and II who were scheduled for elective laparoscopic cholecystectomy under general anaesthesia in Assam Medical College and hospital. Patients were ventilated using a definite algorithm that was previously determined and divided into PCV and VCV groups. Mechanical ventilation parameters - Respiratory Rate, ETCO2, Tidal volume, Peak airway pressure, Plateau pressure, were recorded at baseline - at the time of induction (before insufflation of pneumoperitoneum), at 15 minutes after insufflation of pneumoperitoneum, at 30 minutes and 45 minutes after pneumoperitoneum. Results: In the present study, we have found that the Tidal volume was higher for VCV group at 45 mins of pneumoperitoneum (p<0.01) than in the PCV group. In the present study, we have found statistically significant findings in the Peak Airway Pressure (Peak P) at 15 minutes (p<0.05),30 minutes (p<0.05) and 45 minutes(p<0.01) after insufflation of pneumoperitoneum. The Peak pressures were lower in the PCV group. In the present study, we have found statistically significant lower Plateau Airway Pressures (Plat P) at 15 minutes (p<0.05) and 30 minutes (p<0.05) in PCV group than VCV group after insufflation of pneumoperitoneum. Conclusion: Patients in the PCV group were able to maintain lower airway pressures while delivering target ETCO2 values which is desirable in obese patients. Hence, PCV can be considered as a more efficacious mode for ventilation in patients with BMI25 Kg/m2. However, both modes can be safely used in these patients. [ABSTRACT FROM AUTHOR]

Background: Esophagogastroduodenoscopy (EGD) is an endoscopic examination of the upper gastrointestinal tract that requires insufflation with gas, leading to intra-abdominal hypertension (IAH). There is evidence suggesting that IAH positively correlates with intracranial pressure (ICP) and possibly with intraocular pressure (IOP). The aim of this study was to examine the effect of a routine screening EGD on the IOP. Methods: In this observational study, 25 patients were recruited; 15 males with a mean age of 50 ± 18 years and 10 females with a mean age of 45 ± 14 years. EGD was conducted under sedation in 21 subjects. Both eyes' IOP measurements were performed using Tonopen Avia in the sitting and left lateral decubitus positions before sedation and the start of EGD, and subsequently in the left lateral decubitus position when the endoscope reached the duodenum (D2) and at the end of the procedure. The final measurement was performed in the sitting position 10 min after the end of the procedure. Results: The mean IOP in the sitting position was 15.16 ± 2.27 mmHg, and in the left lateral decubitus position, 15.68 ± 2.82 mmHg. When the gastroscope entered the D2, it was 21.84 ± 6.55 mmHg, at the end of the procedure, 15.80 ± 3.25 mmHg, and 10 min later, 13.12 ± 3.63 mmHg. There was a statistically significant IOP increase when the gastroscope entered the duodenum (p < 0.01). At the end of the gastroscopy, the IOP significantly decreased compared to the one registered when the gastroscope entered the D2 (p < 0.001) and it became similar to the values measured before the EGD, in the same left lateral decubitus position (p > 0.05). Conclusion: Significant changes in IOP were observed during the EGD. IOP fluctuations during EGD should be taken into account, especially in patients that need repeated EGDs during their life or in patients with glaucoma. Further studies are needed to better understand the short-effect and long-effect influence of an IOP increase in these patients. [ABSTRACT FROM AUTHOR]

Recreational drug use is increasingly common in the dermatology patient population and is often associated with both general and specific mucocutaneous manifestations. Signs of substance use disorder may include changes to general appearance, skin, and mucosal findings associated with particular routes of drug administration (injection, insufflation, or inhalation) or findings specific to a particular drug. In this review article, we provide an overview of the mucocutaneous manifestations of illicit drug use including cocaine, methamphetamine, heroin, hallucinogens, marijuana, and common adulterants to facilitate the identification and improved care of these patients with the goal being to connect this patient population with appropriate resources for treatment. [ABSTRACT FROM AUTHOR]

Objectives: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) describes apneic oxygenation using humidified high flow nasal-cannula oxygen. Although it has been described as a sole mode of oxygenation in endoscopic laryngotracheal surgery, its use in endoscopic esophageal surgery under general anesthesia with neuromuscular paralysis has not previously been described. The objective of this study is to assess the safety and efficacy of THRIVE in esophagology. Methods: We conducted a retrospective review of adult patients undergoing esophageal procedures under general anesthesia who were oxygenated using THRIVE at two academic institutions. Demographic, clinical, and anesthesiologic data were collected and analyzed. Results: 14 cases performed from March 2021 to March 2022 met inclusion criteria. 13/14 (92.9%) of patients were able to maintain oxygenation throughout the entirety of their procedure. The mean apneic time was 17.9 minutes with a maximum of 32 minutes. One patient required "rescue" intubation due to failure to maintain oxygenation. Excluding the sole THRIVE failure, the median SpO2 at the conclusion of surgery was 99% (range 94-100%). A linear regression model yielded an increase in EtCO2 of 0.95 mmHg/min or 0.127 kPa/min. SpO2 was negatively associated with both tobacco pack-year smoking history (R2 = 0.343, P =.014) and BMI (R2 = 0.238, P =.038). Conclusion: THRIVE is a feasible, safe, and efficacious means of apneic oxygenation for patients undergoing esophageal endoscopic surgery under general anesthesia with neuromuscular paralysis, which may be particularly beneficial in patients with airway stenosis, as post-intubation changes can have severe clinical implications for this patient population. Obese patients and tobacco smokers may be at increased risk of oxygen desaturation when using THRIVE. [ABSTRACT FROM AUTHOR]

Background: Hypoxaemia occurs in approximately 30% of children during anaesthesia for flexible bronchoscopy. High-flow nasal oxygen (HFNO) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence if HFNO confers advantages over current standard practice in avoiding hypoxaemia. The aim is to investigate feasibility of HFNO use during anaesthesia for flexible bronchoscopy to reduce frequency of rescue oxygenation and hypoxaemia. Methods: BUFFALO is a bi-centre, unmasked, randomised controlled, parallel group, protocol for a pilot trial comparing HFNO techniques to standard practice during anaesthesia. Children (n = 81) aged > 37 weeks to 16 years presenting for elective bronchoscopy who fulfil inclusion but not exclusion criteria will be randomised prior to the procedure to HFNO or standard care oxygenation post induction of anaesthesia. Maintenance of anaesthesia with HFNO requires total venous anaesthesia (TIVA) and with standard, either inhalational or TIVA at discretion of anaesthetist in charge of the patient. Outcomes will include the feasibility of recruitment and adherence to trial procedures, acceptability of the intervention of the protocol and completion rates of data collection methods. Discussion: Findings of this trial will determine feasibility to plan for a larger multicentre randomised clinical trial and support the feasibility of the proposed study procedures. Trial registration: BUFFALO trial was registered with Australia and New Zealand Clinical Trials Registry (TRN12621001635853) on 29 November 2021 and commenced recruitment in May 2022. https://www.anzctr.org.au/. The primary manuscript will be submitted for publication in a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

Background. Several minimal access approaches to the thyroid gland have been widely applied; nevertheless, such approaches are still challenging when dealing with large-sized thyroid nodules or goiters. We hereby evaluated the outcomes and highlighted the merits of endoscopic axillo-breast hemithyroidectomy (EABH) for large-sized unilateral goiters. Methods. Patients underwent EABH for unilateral large thyroid nodules ≥6 cm in its greatest dimension or unilateral large goiter (≥60 ml sonographic volume) whatever the size of its contained nodules were identified from a prospectively maintained database. Their demographic data, clinicopathological profiles, and surgical and esthetic outcomes are reported and analyzed. Results. Over a 2-year period, 33 patients matched the selection criteria. Their mean age was 34.75 ± 11.39 years. There were 30 women and 3 men. The majority of nodules were radiologically TIRADS3 and cytologically Bethesda 3. The mean sonographic dominant nodule greatest dimension was 5.29 ± 1.48 cm (range: 3–9.5 cm). The mean sonographic volume of the pathological lobe was 101.86 ± 54.45 ml (range: 60.11–236.88 ml). All cases were completed endoscopically with no conversion to open. The mean operative time was 110.76 ± 18.75 minutes. No significant postoperative complications were reported except for one case with temporary vocal cord paresis. Most (87.9%) of the patients were extremely satisfied with the procedure. Conclusion. EABH with our suggested key steps could be considered an effective valid approach for unilateral large goiters in trained hands and in patients desirous for cosmesis. [ABSTRACT FROM AUTHOR]

Introduction: The Gastro Laryngeal Mask Airway (LMA) is a newer supraglottic airway device specifically designed for Gastroinstestinal (GI) endoscopy procedures. Hypoxia is a common complication in endoscopy procedures performed under sedation without securing the airway. The Gastro LMA allows for oxygenation, ventilation, and the passage of a gastroscope through its integrated endoscope channel. Aim: To evaluate the utility of the Gastro LMA compared to nasal prongs in maintaining oxygenation and airway control during upper GI endoscopy procedures. Materials and Methods: The present double-blinded randomised, single-centre clinical study conducted in the Department of Anaesthesiology, GCS Medical College Hospital and Research Centre, Ahmedabad, Gujarat, India included 50 adult patients scheduled for elective GI endoscopy procedures in the supine or lateral position. The patients were divided into two equal groups: Group G (Gastro LMA) and Group N (Nasal prong). Preprocedural heart rate and SpO2 levels were noted. All patients were observed for hypoxia (SpO2 <92%), bradycardia, lowest heart rate and Saturation of Peripheral Oxygen (SpO2) levels, conversion to endotracheal intubation, and any other intraoperative adverse events. Postoperatively, patients were observed for four hours for adverse effects and discharged after assessment using the modified Aldrete's score. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0, and the results were expressed as percentages, mean ± SD, and p-values. results: Out of the 50 patients, 23 were male and 27 were female, with a median age of 59 years. The preprocedural mean lowest heart rate in Group G was 68/min, and in Group N it was 64/min. The mean lowest SpO2 during the procedure was 94% in Group N and 96% in Group G. In Group N, two patients (8%) required conversion to endotracheal intubation. One patient had a longer duration of the procedure and experienced bronchospasm, while another patient with Chronic Obstructive Pulmonary Disease (COPD) developed bronchospasm. In Group G, one patient (4%) required endotracheal intubation, possibly due to increased intrabdominal pressure caused by air insufflation in an obese patient. conclusion: In patients undergoing gastrointestinal endoscopy procedures, the Gastro LMA appears to be effective for clinical use. It provides good airway control and enables deeper sedation without respiratory compromise. Ventilation was well maintained with minimal intraoperative and postoperative adverse events. [ABSTRACT FROM AUTHOR]

Background: Open sublay and laparoscopic IPOM repair have specific disadvantages and risks. In recent years, this evidence led to a paradigm shift and induced the development of new minimally invasive techniques of sublay mesh repair. Methods: Pioneering this trend, we developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed trans-hernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. After dissection of an extra-peritoneal space of at least 8 cm, port placement and CO2 insufflation, each MILOS operation can be continued endoscopically (EMILOS repair). All E/MILOS operations were prospectively documented in the Herniamed Registry with 1- and 5-year questionnaire follow-ups. Propensity score matching of incisional hernia operations comparing the results of the E/MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from all other institutions participating in the Herniamed Registry was performed. The results with perioperative complications and 1-year follow-up have been published previously. Results: This paper reports on the 5-year results. The 5-year follow-up rate was 87.5% (538 of 615 patients with E/MILOS incisional hernia operations). Comparing E/MILOS repair with laparoscopic IPOM and open sublay operation, propensity score matching analysis was possible with 448 and 520 pairs of operations, respectively. Compared with laparoscopic IPOM incisional hernia operation, the E/MILOS repair is associated with significantly fewer general complications (P = 0.004), recurrences (P < 0.001), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.016) and tends to result in fewer postoperative complications (P = 0.052), and less pain at rest (P = 0.053). Matched pair analysis with open sublay repair revealed significantly fewer general complications (P < 0.001), postoperative complications (P < 0.001), recurrences (P = 0.002), less pain at rest (P = 0.004), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.014). A limitation of this analysis is a relative low 5-year follow-up rate for laparoscopic IPOM and open sublay. Conclusions: The E/MILOS technique allows minimally invasive trans-hernial repair of incisional hernias using large standard meshes with low morbidity and good long-term results. The technique combines the advantages of sub-lay repair and a mini- or less-invasive approach. Trial registration: ClinicalTrials.gov Identifier NCT03133000. [ABSTRACT FROM AUTHOR]

A case is described in which appendicitis presented in a 73-year-old woman the day after a colonoscopy. Possible mechanisms for appendicitis aggravated by colonoscopy include barotrauma, irritation by residual glutaraldehyde type solution used for cleaning the endoscope, fecalith, and/or appendicolith being pushed into the orifice of the appendix by insufflation during the colonoscopy. This rare complication is likely most often unavoidable due to the pressure required to properly visualize the colon (which typically ranges from 9 to 57 mmHg) and the manipulation required to visualize and cannulate the ileocecal valve. Physicians should consider possibility of acute appendicitis after colonoscopy when evaluating abdominal pain after a recent colonoscopy. [ABSTRACT FROM AUTHOR]

The AirSeal system (CONMED, NY, USA) can outstandingly keep pneumoperitoneum stable. However, water droplets form on the access port, impairing the performance of comfortable surgical procedures because of the resultant wet surgical field. This study was performed to clarify the mechanism of water droplet formation and to prevent it. Condensation was observed on the AirSeal system. A heater was wrapped around the tri-lumen tube, and the heating effect was assessed. The simulator experiments revealed that condensation formed in the tri-lumen tube and on the wall of the access port. The accumulated weight of the condensation on the wall of the access port was 41.6 g in the Heated group, 138.2 g in the Control group, and 479.4 g in the Cooled group. In the clinical assessment, the accumulated volume of the condensation attached to the inside wall was significantly smaller in the Heated group than in the Unheated group (111.7 g vs. 332.9 g, respectively). We clarified that the volume of condensation attached to the wall of the access port depended on the temperature of the tri-lumen tube. The clinical study revealed that the condensation on the access port was reduced by heating the tri-lumen tube. The development of a novel heating device for the insufflation tube would be effective and useful. [ABSTRACT FROM AUTHOR]

Background: Maintenance of normothermia is a crucial part of enhanced recovery after colorectal surgery. Dry‐cold carbon dioxide (CO2) traditionally used for insufflation in laparoscopic surgery and negative pressure operating theatres has been associated with intraoperative hypothermia. Studies suggest that use of warmed‐humidified CO2 may promote normothermia. However, due to a scarcity of high‐quality studies demonstrating a proven benefit on intraoperative core body temperature, its use in colorectal surgery remains limited. Therefore, the aim of this review was to evaluate the effects of warmed‐humidified CO2 compared to traditional dry‐cold CO2, or ambient air in operating theatres, during colorectal surgery. Methods: A search of Medline, EMBASE, and CENTRAL was performed. Randomised controlled trials (RCTs) that compared patients receiving warmed‐humidified CO2 with either dry‐cold CO2 insufflation in laparoscopic procedures or no insufflation during open surgery were included. The primary outcome was change in intraoperative core body temperature. Secondary outcomes included length of stay, operating time, return of gastrointestinal function, wound infection, and postoperative pain. A pairwise meta‐analysis was performed using inverse variance random effects. Results: Among the six RCTs included, 208 patients received warmed‐humidified CO2 (42.3% female, mean age: 65.8 years) and 210 patients received either dry‐cold CO2 in laparoscopic procedures or no gas insufflation during open procedures (46.2% female, mean age: 66.1 years). No significant difference was found for change in intraoperative core body temperature (MD = 0.01, 95% CI: −0.1, 0.11, p = 0.90, very low certainty). Patients in the warmed‐humidified CO2 group had significantly higher pain scores on postoperative day 1 (MD = 1.61, 95% CI: 0.91, 2.31, p < 0.05, very low certainty). No significant differences were found in any of the other secondary outcomes studied. Conclusion: Patients undergoing colorectal surgery receiving warmed‐humidified CO2 do not experience any clinically meaningful difference in core body temperature change compared to their counterparts receiving dry‐cold CO2 insufflation or no insufflation. However, patients may report greater pain scores on postoperative day 1 with warmed‐humidified CO2. There is likely no clinically important difference between warmed‐humidified CO2 and dry‐cold CO2 for patients undergoing colorectal surgery. Patient, clinician, and institution factors should be considered when deciding between these two insufflation modalities. [ABSTRACT FROM AUTHOR]

Introduction: Post-thoracotomy air leaks remain a significant challenge in thoracic surgery. Aim: This randomized controlled trial assessed the efficacy of autologous fibrin glue in reducing air leaks following thoracotomy procedures. Material and methods: Conducted as a single-center, single-blind, randomized clinical trial, the study enrolled adult patients undergoing lung resection or decortication at a thoracic surgery clinic. Participants were randomly assigned to either the intervention group, receiving autologous fibrin glue application during surgery, or the control group, undergoing standard surgical procedures without glue application. Key inclusion criteria were adult patients undergoing elective thoracotomy for lung resection or decortication, while exclusion criteria included patients with severe comorbidities or contraindications to fibrin glue. Results: A total of 40 patients were enrolled and randomized equally to the two groups. The group treated with autologous fibrin glue demonstrated a significant reduction in the duration of air leakage and chest tube drainage, along with a shorter hospital stay, compared to the control group. There were no statistically significant differences in postoperative complications between the groups. Conclusions: The application of autologous fibrin glue during thoracotomy procedures significantly reduces postoperative air leaks and hospitalization duration without increasing complication rates. This finding suggests a beneficial role of fibrin glue in thoracic procedures requiring lung resection or decortication. [ABSTRACT FROM AUTHOR]

This document is a compilation of abstracts from the journal Anaesthesia, covering a wide range of research projects and quality improvement initiatives in the field of anaesthesia. The abstracts touch on topics such as maternal care, anaesthesia usage, obesity in surgical patients, pain management, peri-operative care, and patient safety. These abstracts offer a glimpse into the current research and advancements in anaesthesia and can be a valuable resource for library patrons conducting research in this field. [Extracted from the article]

Introduction: Laparoscopic cholecystectomy is now preferred over the open procedure due to advantages such as reduced blood loss and shorter hospital stays. However, concerns have been raised regarding the potential for increased Intra-abdominal Pressure (IAP) during laparoscopic procedures, which may impact haemodynamic stability and respiratory parameters. However, there is a lack of comprehensive analysis directly comparing both surgical approaches from both haemodynamic and capnographic perspectives. Aim: To compare the haemodynamic and capnographic changes between laparoscopic and open cholecystectomy. Materials and Methods: This randomised clinical study was conducted at Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India from May 2021 to June 2022. The study included 300 patients scheduled for cholecystectomy, divided into two groups: Laparoscopic Cholecystectomy (LC) Group I (n=150) and Open Cholecystectomy (OC) Group II (n=150). Haemodynamic parameters, including Pulse Rate (PR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Oxygen Saturation (SpO2), were recorded. Capnographic parameters, such as End-Tidal Carbon Dioxide (EtCO2) levels, were also measured at regular intervals. Data analysis was performed using the student's t-test and Chi-square test with Statistical Package for Social Sciences (SPSS) version 21.0 software and Microsoft excel. Results: There were no significant differences in age, body weight, and sex distribution between Group I and Group II. However, significant differences were observed in PR and SBP at 15 minutes (PR: 101.46 and 95.86; SBP: 148.57 and 140.97), 30 minutes (PR: 104.52 and 99.82; SBP: 141.28 and 136.07), and 45 minutes (PR: 102.52 and 97.70; SBP: 140.59 and 133.95) (p-value <0.01). Highly significant differences were observed in MAP and EtCO2 postinsufflation at 15 minutes (MAP: 118.38 and 108.61; EtCO2: 36.48 and 33.89), 30 minutes (MAP: 111.11 and 106.01; EtCO2: 41.02 and 36.15), 45 minutes (MAP: 110.73 and 103.48; EtCO2: 42.65 and 38.36), and 60 minutes (MAP: 106.08 and 101.45; EtCO2: 41.10 and 38.21) (p-value <0.01). DBP showed high significance at 15 minutes (103.21 and 93.23), 30 minutes (96.74 and 92.57), and 60 minutes (93.14 and 86.92) (p-value <0.01), and significant (p-value=0.01) at 45 minutes (95.53 and 87.59). Oxygen saturation showed significance (p-value <0.05) at 15 minutes (99.93 and 100). Conclusion: The present study demonstrated a significant increase in both haemodynamic and capnographic parameters, even in American Society of Anaesthesiologists (ASA) Grade-I and Grade-II patients undergoing laparoscopic cholecystectomy compared to the open surgical technique. These findings emphasise the need for careful monitoring during laparoscopic procedures. [ABSTRACT FROM AUTHOR]

Background: Conventional operative insufflation uses a one-way trocar to handle instruments while maintaining pneumoperitoneum. In 2007, the AirSeal® valveless trocar insufflation system was introduced, which maintains stable pneumoperitoneum while continuously evacuating smoke. Although this device has been validated in adult patients, it has not been extensively validated in the pediatric population. Materials and Methods: A retrospective cohort study of pediatric urology patients aged 0 to 21 who underwent laparoscopic pyeloplasty between March 2016 and October 2021 was performed. Intraoperative physiologic parameters, procedure characteristics, postoperative outcomes, and demographics of each patient in whom either AirSeal insufflation system (AIS) or conventional insufflation system (CIS) was utilized were obtained from hospital records. Data were compared across the AIS and CIS cohorts. The primary outcomes were intraoperative anesthetic and physiologic parameters, including end tidal carbon dioxide, oxygen saturation, body temperature, positive inspiratory pressure, systolic blood pressure, and heart rate. Results: There were no significant differences in the anesthetic and physiologic parameters in the AIS and CIS groups. In addition, no differences in demographics, procedural characteristics, or complication rates were found between the cohorts. Conclusion: The AirSeal valveless trocar insufflation system demonstrates comparable intraoperative anesthetic and physiologic outcomes compared to conventional one-way valve insufflation in pediatric laparoscopic pyeloplasty. Certain surgeon-related qualitative metrics are underappreciated in this study, however, including improved visualization with vigorous suctioning and pressure maintenance with frequent instrument exchanges. Surgeon experience may mask the benefits of these characteristics as it pertains to quantitative surgical outcomes such as estimated blood loss, operative time, and perioperative complications. [ABSTRACT FROM AUTHOR]

Context: In the era of minimally invasive surgeries, pediatric laparoscopic surgeries are now becoming the standard of care. Aim: In this study, we aim to determine the safe and optimal pneumoperitoneal pressures (PPs) for laparoscopic surgery in children aged 1-5 years, along with the technical ease for the surgeon. Settings and Design: Prospective, randomized, single blinded study was conducted at SGPGI Lucknow. Materials and Methods: Children aged 1-5 years were randomized into Group I (n = 24): PP = 6-8 mmHg and Group II: (PP) = 9-10 mmHg. Hemodynamic, ventilatory, and blood gas changes were measured before CO2 insufflation (T0), 20 min after insufflation (T1), before desufflation (T2), and 10 min after desufflation (T3). Surgeon's technical ease of surgery, postoperative pain, the requirement of rescue analgesia, time to resume feeding, and complications were recorded and analyzed. Statistical Analysis Used: Paired t test, Mann--Whitney test, and Wilcoxon signed rank test were used for nonparametric/parametric data. Chi-square/Fisher's test was used for nominal data. Results: Partial pressure of CO2 (PaCO2) was significantly higher in Group II at T1, T2, and T3, requiring frequent changes in ventilatory settings. Postoperative pain scores were higher in Group II at 1, 6, and 12 h, requiring rescue analgesia. Surgeon's scores and hemodynamics were similar in both groups. Conclusions: Higher PP in Group II caused significant changes in PaCO2, end tidal CO2, and postoperative pain requiring rescue analgesia, but blood gas changes were clinically insignificant and there were no significant changes in hemodynamic parameters. Since the surgeon's ease of performing surgery was similar in both groups, we recommend that laparoscopy in children aged 1-5 years can be started with lower PPs of 6-8 mmHg, which can be increased if needed based on the surgeon's comfort and the patient's body habitus. [ABSTRACT FROM AUTHOR]

Accurate identification of the intersegmental plane is the key to successful segmentectomy. This case series included 41 patients who underwent uniportal thoracoscopic segmentectomy using the open insufflation method to identify the intersegmental plane for pulmonary nodules. The median age of the patients was 58 (range 35–73) years, and 63.4% were female. Malignant pulmonary nodules accounted for 80.5% of cases and were staged as 0–IA2. Seventeen patients underwent a single subsegmentectomy or single segmentectomy, and 24 underwent combined subsegmentectomy or subsegmentectomy combined with segmentectomy. There was no conversion to multiportal video-assisted thoracoscopic surgery, open surgery, or lobectomy. The median operative time was 84 (range 45–194) min, and the median blood loss was 50 (range 10–150) ml. The median chest tube duration and postoperative hospital stay were 2 (range 1 − 7) days. One (2.4%) developed an air leak for >5 days. No deaths occurred within 30 days after surgery. [ABSTRACT FROM AUTHOR]

Background High-flow nasal cannula showed success in some coronavirus disease 2019 (COVID-19) patients. High-velocity nasal insufflation (Hi-VNI) is a refined form of high-flow nasal cannula that delivers heated and humidified gas with high velocity through a simple small-bore nasal cannula. Objective To assess the impact of early use of Hi-VNI in improving hypoxemia and respiratory distress and its effect on the length of ICU stay in COVID-19 patients presented with acute respiratory failure. Patients and methods In total, 30 patients with confirmed COVID-19 presented with respiratory failure admitted to intensive care of COVID-19 zone were recruited to the study from October 2021 to February 2022. They were categorized into two groups: early and late Hi-VNI groups according to whether the shift to Hi-VNI occurred after low-flow nasal cannula or non-rebreathing mask, respectively. Results Successful outcome was achieved in 73.3% in early Hi-VNI group versus 53.3% in late Hi-VNI group. Regarding successful outcome, the duration of Hi-VNI and ICU stay was significantly (P <0.001) lower in early Hi-VNI group. Higher inflammatory markers and lymphopenia are predictors of failure. Conclusion The early use of Hi-VNI in hypoxemic respiratory failure of COVID-19 achieved better improvement of respiratory distress, oxygenation, and shorter ICU stay. [ABSTRACT FROM AUTHOR]

Background: 3D printing is an additive manufacturing process that uses incrementally timed layers of materials to build 3D objects. Colorectal cancer is the second most frequent cancer, affecting over one million people each year. Over the past decade, TAMIS (transanal minimally invasive surgery) has gained interest for resection of early rectal carcinoma. However the conventional SILS (single-incision laparoscopic surgery) port used in TAMIS had a few drawbacks. To date there are no studies evaluating the 3D printing of SILS port. The purpose of this study is to evaluate the clinical safety and operability of 3D printed SILS port and compare the efficacy of same over conventional SILS port in TAMIS. Methods: This is a randomised control study conducted in Victoria Hospital Bengaluru from October 2022 to March 2023 included 36 patients who underwent TAMIS using conventional SILS port and 3D printed SILS port. Data on technical aspects of 3D printed SILS port over conventional port were assessed using various parameters. Results: In our study the port placement using 3D printed port was very easy in 38.9% of the patients as compared to conventional port where it was 11.1%. Similarly, easy instrumentation and good insufflation was found in 55.6% with 3D printed port as compared to conventional port (5.6%),whereas durability of conventional port was good in 50% of cases compared to 3D printed port which was only 11.1%. Conclusion:We infer from our study that the 3D printing of SILS port is technically a feasible procedure and demonstrates potential advantages over the conventional port in terms of port placement, instrumentation and insufflation with a better surgical outcome. [ABSTRACT FROM AUTHOR]

CPZEN-45 is a novel compound with activity against drug-susceptible and drug-resistant tuberculosis (TB). The present study was undertaken to determine the best dose and dosing regimen of inhalable CPZEN-45 powders to use in efficacy studies with TB-infected guinea pigs. The disposition of CPZEN-45 after intravenous, subcutaneous (SC), and direct pulmonary administration (INS) was first determined to obtain their basal pharmacokinetic (PK) parameters. Then, the disposition of CPZEN-45 powders after passive inhalation using consecutive and sequential doses was evaluated. Plasma concentration versus time curves and PK parameters indicated that the absorption of CPZEN-45 after INS was faster than after SC administration (Ka = 12.94 ± 5.66 h−1 and 1.23 ± 0.55 h−1, respectively), had a longer half-life (2.06 ± 1.01 h versus 0.76 ± 0.22 h) and had higher bioavailability (67.78% and 47.73%, respectively). The plasma concentration versus time profiles and the lung tissue concentration at the end of the study period were not proportional to the dose size after one, two, and three consecutive passive inhalation doses. Three sequential passive inhalation doses maintained therapeutic concentration levels in plasma and lung tissue for a longer time than three consecutive doses (10 h vs. 3 h, respectively). Future studies to evaluate the efficacy of inhaled CPZEN-45 powders should employ sequential doses of the powder, with one nominal dose administered to animals three times per day. [ABSTRACT FROM AUTHOR]

Accessing the pericardial space safely and efficiently is an important skill for interventional cardiac electrophysiologist. With the increased recognition of the complexity of the 3‐dimensional arrhythmogenic substrate due to advances in imaging and mapping technologies there has been an expansion of epicardial procedures in recent years. Equally, minimally invasive implantation of epicardial pacing, cardiac resynchronization, or defibrillation leads is expanding in specific patients where transvenous systems are contraindicated or their long term sequelae should be ideally avoided. Selective delivery of intrapericardial pharmacological antiarrhythmic therapy is yet another potential indication, albeit still investigational. The expanding indications for percutaneous epicardial procedures is contrasted by the still substantial risk and challenges associated with accessing the pericardial space. Myocardial perforation, coronary artery laceration, and damage to the surrounding organs are all recognized and feared complications. A number of innovative epicardial access techniques have been proposed to overcome the difficulties and risks of traditional dry subxiphoid punctures and may allow for more widespread use of epicardial access in the future. We review 10 different established and novel subxiphoidal epicardial access techniques describing procedural success rates, safety profile and overall experience. The technical aspects as well as access times and costs for extra equipment will be reviewed. Finally, an outlook of reported preclinical techniques awaiting in‐human feasibility studies is provided. [ABSTRACT FROM AUTHOR]

Introduction: Mechanical Insufflation‐Exsufflation (MI‐E) is used as an airway clearance intervention in primary care (home ventilation), long‐term care (prolonged rehabilitation after intensive care, neuromuscular diseases, and spinal cord injury), and increasingly in acute care in intensive care units (ICU). Aim: We sought to develop in‐depth understanding of factors influencing decision‐making processes of health care professionals regarding initiation, escalation, de‐escalation, and discontinuation of MI‐E for invasively ventilated patients including perceived barriers and facilitators to use. Methods: We conducted focus groups (3 in the Netherlands; 1 with participants from four European countries) with clinicians representing the ICU interprofessional team and with variable experience of MI‐E. The semi‐structured interview guide was informed by the Theoretical Domains Framework (TDF). Two researchers independently coded data for directed content analysis using codes developed from the TDF. Results: A purposive sample of 35 health care professionals participated. Experience varied from infrequent to several years of frequent MI‐E use in different patient populations. We identified four main themes: (1) knowledge; (2) beliefs; (3) clinical decision‐making; and (4) future adoption. Conclusion: Interprofessional knowledge and expertise of MI‐E in invasively ventilated patients is limited due to minimal available evidence and adoption. Participants believed MI‐E a potentially useful intervention for airway clearance and inclusion in weaning protocols when more evidence is available. Relevance to Clinical Practice: This focus group study provides an overview of current practice, knowledge and expertise, and barriers and facilitators to using MI‐E in mechanically ventilated patients. From these data, it is evident there is a need to develop further clinical expertise and evidence of efficacy to further understand the role of MI‐E as an airway clearance technique for ventilated patients. [ABSTRACT FROM AUTHOR]

Background: Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The performance of supraglottic devices versus tracheal tubes in children undergoing laparoscopic surgery is uncertain. Methods: A systematic review and meta‐analysis of randomized controlled trials that compared supraglottic devices versus tracheal tubes in patients ≤18 years undergoing laparoscopic surgery under general anesthesia was conducted. The outcomes were peak airway pressures (cm H2O), end‐tidal carbon dioxide during pneumoperitoneum (mm Hg), recovery time (min), postoperative sore throat and adverse events. Mean difference and odds ratio, with 95% confidence intervals were reported using a random effect model. Results: Eight trials (n = 591) were included in the final meta‐analysis. There was no statistically significant difference in the peak airway pressures (MD 0.58, 95% CI: −0.65 to 1.8; p =.36) and end‐tidal carbon dioxide (MD −0.60, 95% CI: −2.00 to 0.80; p =.40) during pneumoperitoneum in the supraglottic device and the tracheal tube group. The tracheal tube group had higher odds of sore throat (OR 3.30, 95% CI: 1.69–6.45; p =.0005) and the supraglottic airway group had faster recovery time (MD 4.21, 95% CI: 3.12–5.31; p <.0001), which were statistically significant. The certainty of evidence is graded low. Conclusion: There is low quality evidence to suggest that for pediatric laparoscopic surgeries of short duration, supraglottic devices could provide comparable intraoperative ventilation in terms of peak airway pressures and end tidal carbon dioxide, with lower odds of postoperative sore throat and faster recovery time when compared to tracheal tubes. [ABSTRACT FROM AUTHOR]

Background: During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage. Therefore, this study compares particle escape from a valveless (Conmed AirSeal iFS), and a conventional (Karl Storz Endoflator) system. Materials and methods: Using an in vitro model, a conventional and a valveless trocar system were compared. A protocol that simulated various surgical phases was defined to assess the surgical conditions and particle leakage. Insufflation pressures and instrument diameters were varied as these are known to affect gas leakage. Results: The conventional trocar leaked during two distinct phases. Removal of the obturator caused a sudden release of particles. During instrument insertion, an average of 211 (IQR 111) particles per second escaped when using the 5 mm diameter instrument. With the 10 mm instrument, 50 (IQR 13) particles per second were measured. With the conventional trocar, a higher abdominal pressure increased particle leakage. The valveless trocar demonstrated a continuously high particle release during all phases. After the obturator was removed, particle escape increased sharply. Particle escape decreased to 1276 (IQR 580) particles per second for the 5 mm instrument insertion, and 1084 (IQR 630) particles per second for 10 mm instrument insertion. With the valveless trocar system, a higher insufflation pressure lowered particle escape. Conclusions: This study shows that a valveless trocar system releases more particles into the operating room environment than a conventional trocar. During instrument insertion, the leakage through the valveless system is 6 to 20 times higher than the conventional system. With a valveless trocar, leakage decreases with increasing pressure. With both trocar types leakage depends on instrument diameter. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the interactions between histaminergic system and glucocorticoid-induced leucin zipper (GILZ) in the inflammatory process and glucocorticoid modulation in lung fibrosis. Methods: Wild-type (WT) and GILZ Knock-Out (KO) mice were treated with bleomycin (0.05 IU) or saline, delivered by intra-tracheal injection. After surgery, mice received a continuous infusion of JNJ7777120 (JNJ, 2 mg/kg b.wt.) or vehicle for 21 days. Lung function was studied by measuring airway resistance to air insufflation through the analysis of pressure at airway opening (PAO). Lung samples were collected to evaluate the expression of histamine H4R, Anx-A1, and p65-NF-kB, the activity of myeloperoxidase (MPO), and the production of pro-inflammatory cytokines. Results: Airway fibrosis and remodeling were assessed by measuring TGF-β production and α-SMA deposition. JNJ reduces PAO in WT but not in GILZ KO mice (from 22 ± 1 mm to 15 ± 0.5 and from 24 ± 1.5 to 19 ± 0.5 respectively), MPO activity (from 204 ± 3.13 pmol/mg to 73.88 ± 2.63 in WT and from 221 ± 4.46 pmol/mg to 107 ± 5.54 in GILZ KO), the inflammatory response, TGF-β production, and α-SMA deposition in comparison to WT and GILZ KO vehicle groups. Conclusion: In conclusion, the role of H4R and GILZ in relation to glucocorticoids could pave the way for innovative therapies to counteract pulmonary fibrosis. [ABSTRACT FROM AUTHOR]

This clinical case shows the repercussions of acute exposure to cement dust in the respiratory tract and other mucous membranes. Following a cement dust pipe explosion, the patient endured a severe inhalation of dust. A combination of rigid bronchoscopy and a mechanical insufflation–exsufflation system was employed to remove cement debris from the airways. Respiratory physiotherapy sessions were implemented for effective secretion clearance, contributing to a successful short-term recovery. While this remains an isolated case, the unconventional techniques employed provide valuable insights for potential similar scenarios in the future. [ABSTRACT FROM AUTHOR]

Pulmonary physiology is significantly altered during underwater exposure, as immersion of the body and increased ambient pressure elicit profound effects on both the cardiovascular and respiratory systems. Thoracic blood pooling, increased breathing gas pressures, and variations in gas volumes alongside ambient pressure changes put the heart and lungs under stress. Normal physiologic function and fitness of the cardiovascular and respiratory systems are prerequisites to safely cope with the challenges of the underwater environment when freediving, or diving with underwater breathing apparatus. Few physicians are trained to understand the physiology and medicine of diving and how to recognize or manage diving injuries. This article provides an overview of the physiologic challenges to the respiratory system during diving, with or without breathing apparatus, and outlines possible health risks and hazards unique to the underwater environment. The underlying pathologic mechanisms of dive-related injuries are reviewed, with an emphasis on pulmonary physiology and pathophysiology. [ABSTRACT FROM AUTHOR]

Respiratory management is an important aspect of care in neuroanesthesia practice for neurosurgical patients. A wide variety of procedures are performed under sedation in the neurosurgical population, and maintaining oxygenation is of paramount importance during these procedures. The high-flow oxygen devices improve arterial oxygenation by providing higher inspiratory oxygen concentration and maintaining higher dynamic positive airway pressure. These devices have gained importance during the recent years with regard to enhancing patient safety. This narrative review focuses on the role of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) and high-flow nasal oxygenation (HFNO) techniques in the neuroanesthesia practice and electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

Introduction: Ischaemic preconditioning is the most effective method for the prevention of ischaemic-reperfusion injury; however, no study has examined the question of the ideal time for ischaemic preconditioning. Patients and Methods: The patients were divided into five groups, each group including of 20 patients. The precondition was applied as 1, 5, 10 and 15 min in Groups I, II, III and IV and Group V was the control group. Repeated blood samples were taken to measure the total antioxidant status (TAS), total oxidant status and oxidative stress index (OSI) values, just before insufflation, at the end of the operation and at 6 and 24 h of the post-operative period. Results: A significant difference was observed between the TAS values at the end of the operation and at the sixth post-operative time of the four groups (P = 0.001, 0.000, 0.001, 0.019 and 0.033, respectively). Furthermore, a significant difference was observed between TAS values at the post-operative 24th h of Group III and Group V, and also a significant difference was observed between the OSI values at the post-operative 6th h of Groups III and V. Conclusion: The low OSI and TAS values may interpret as a low degree of oxidative damage. The OSI values at the post-operative 6 h of Groups I and II were lower than those of other groups. We accept this result as low oxidative damage. [ABSTRACT FROM AUTHOR]

Introduction: The therapeutic strategy for superficial nonampullary duodenal epithelial tumors remains controversial. We developed a novel surgical technique for superficial nonampullary duodenal epithelial tumors. We report the initial two cases managed with this method. Materials and surgical technique: We endoscopically confirmed the tumor location and circumferentially incised the seromuscular layer of the duodenum along it. After circumferential seromyotomy, the submucosal layer was expanded by endoscopic insufflation, and the target lesion was sufficiently lifted. The submucosal layer, including the target lesion, was stapled and resected after confirming the absence of problems with endoscopic passage. The seromuscular layer was continuously sutured to bury and reinforce the stapler line. Single-incision laparoscopic surgery was performed in one case. The resected specimens measured 52 x 32 mm and 50 x 26 mm with negative surgical margins. Both patients were discharged without complications and demonstrated no evidence of stenosis. Discussion: Compared with previously reported procedures, this method of partial duodenectomy with seromyotomy for superficial nonampullary duodenal epithelial tumors is promising, simple, and safe. [ABSTRACT FROM AUTHOR]

Background: Recurrent primary spontaneous pneumothorax (PSP) is routinely treated by video‐assisted thoracoscopic (VATS) talc pleurodesis (with or without localized resection of macroscopic bullous disease). There is a paucity of published data regarding durability of the procedure and the rate of recurrent pneumothorax after such surgery, and this has significant implications from a prognostic and employment limitation perspective. Methods: Patients who underwent a VATS talc pleurodesis (with or without localized resection of macroscopic bullous disease) for the treatment of their second or subsequent PSP or a PSP were followed for recurrent ipsilateral pneumothorax and new contralateral PSP. Follow up was by way of telephone interview and medical record verification out to 48 months. Results: New contralateral pneumothorax occurred in 7 patients (11.1%) in the talc pleurodesis plus wedge resection group and 2 (1.8%) in the talc pleurodesis only group. There was one case of recurrent ipsilateral pneumothorax in a patient who had no inflammatory response to talc insufflation. Conclusion: Video‐assisted thoracoscopic (VATS) talc pleurodesis (and lung resection for macroscopic bullous disease) is a durable treatment for recurrent PSP. Patients with macroscopic disease have a significant risk of subsequent contralateral PSP. Recurrence rates for spontaneous pneumothorax rates post intervention with VATS talc pleurodesis ± resection of bullous disease. VATS talc pleurodesis (and lung resection for macroscopic bullous disease) is a durable treatment for recurrent primary spontaneous pneumothorax (PSP). Patients with macroscopic disease have a significant risk of subsequent contralateral PSP. [ABSTRACT FROM AUTHOR]

Objective: We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers. Background: The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12–14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines. Methods: A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8–10 mmHg) vs. standard-pressure (12–14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. Results: one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs. 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons. Conclusion: low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022). [ABSTRACT FROM AUTHOR]

Background: Proper mask ventilation is important to prevent air inflow into the stomach during induction of general anesthesia, and it is difficult to send airflow only through the trachea without gastric inflation. Changes in gastric insufflation according to mask ventilation during anesthesia induction were compared. Methods: In this prospective, randomized, single-blind study, 230 patients were analyzed to a facemask-ventilated group (Ventilation group) or no-ventilation group (Apnea group) during anesthesia induction. After loss of consciousness, pressure-controlled ventilation at an inspiratory pressure of 15 cmH2O was performed for two minutes with a two-handed mask-hold technique for Ventilation group. For Apnea group, only the facemask was fitted to the face for one minute with no ventilation. Next, endotracheal intubation was performed. The gastric cross-sectional area (CSA, cm2) was measured using ultrasound before and after induction. After pneumoperitoneum with carbon dioxide, gastric insufflation of the surgical view was graded by the surgeon for each group. Results: Increase of postinduction antral CSA on ultrasound were not significantly different between Ventilation group and Apnea group (0.04 ± 0.3 and 0.02 ± 0.28, p-value = 0.225). Additionally, there were no significant differences between the two groups in surgical grade according to surgeon's judgement. Conclusions: Pressure-controlled ventilation at an inspiratory pressure of 15 cmH2O for two minutes did not increase gastric antral CSA and insufflation of stomach by laparoscopic view. Trial Registration: http://cris.nih.go.kr (KCT0003620) on 13/3/2019. [ABSTRACT FROM AUTHOR]

In the Laparoscopic Approach to Cervical Cancer trial, minimally invasive surgery (MIS) has been associated with significantly lower disease-free survival and overall survival rates. The proposed reasons for the increased recurrence and mortality associated with MIS are uterine manipulation, the effect of insufflation gas (CO2), and intracorporeal colpotomy. We applied 2 techniques during surgery to reduce tumor spillage in laparoscopic radical hysterectomy (LRH), which included avoiding using a uterine manipulator and containing the colpotomy using an endoscopic stapler. We aimed to introduce an easy and comfortable traction method with tagged uterine sutures instead of a manipulator or vaginal tube for minimally invasive radical hysterectomy (RH). The patient underwent LRH. After entering the peritoneal cavity, tubal ligation was performed with an endoscopic clip to prevent tumor spillage via the fallopian tubes. Then, the uterine fundus was tied with needle-straightened multifilament Vicryl 2-0, and the tagged uterus was manipulated. Thereafter, pelvic lymphadenectomy was performed before RH. Thereafter, we performed intracorporeal colpotomy by resecting the vagina twice using an endoscopic stapler. Finally, the stapled vaginal stump was resected to retrieve the specimen via the vaginal opening using monopolar scissors after the vagina was washed several times with sterile water. After removing the specimen, the vaginal stump was endoscopically closed with a barbed suture. LRH can be feasibly performed in patients with uterine cervical neoplasm by retracting tagged uterine sutures without the use of a uterine manipulator. [ABSTRACT FROM AUTHOR]

Background: Recently, a non-commercial oxygenation laryngoscope was able to maintain apneic oxygenation during simulated intubation efforts. Since that prototype was 3 mm wider than a standard Macintosh laryngoscope blade, the intubation performance of this device may differ from standard blades. A new prototype of an oxygenation laryngoscope was developed, consisting of a standard-size Macintosh blade and a fixed oxygen supply line to the side. Actually, it is unclear at which point of this blade the oxygen supply line should end to facilitate the best possible oxygen supply for apneic oxygenation. Methods: In this simulation study using a standardized human airway manikin, the efficacy of apneic oxygenation by oxygen insufflation using standard and modified Macintosh blades was compared: a standard Macintosh blade without oxygen supply line as control, one with an additional oxygen supply line ending proximal near the handle, one with the line ending at the middle of the blade, and one with the line ending near the tip. A preoxygenated test lung was connected to an oximeter with a flow rate of 200ml/min, simulating oxygen consumption of a male adult, and to the trachea of an anatomically correctly shaped airway manikin. Apneic oxygenation was performed and oxygen content was measured over a 20-minutes observation period. Experiments were repeated five times for each laryngoscope blade. Results: Oxygen percentage in the test lung dropped from 100 ± 0% at the start of the experiment to 53 ± 1.5% in the room air control group (p < 0.001 compared to all other groups), and to 74 ± 2.5% in the proximal oxygen line group, whereas oxygen percentage remained at 100% in both the medium and distal oxygen line groups (p = 1 between these groups; p < 0.001 between all other groups). Conclusions: In this simulation study with a preoxygenated airway manikin, the use of a modified Macintosh laryngoscope blade with oxygen line attached at the tip or at the middle were able to maintain apneic oxygenation without measurable drop of oxygen content over 20 min. Proximal placement of the oxygen supply line still showed an advantage against room air, however it did not completely prevent room air from entering the airway. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: The conventional method of irrigation during laparoscopy and endoscopy is well documented in literature. The use of nebulizer or underwater sealed chest tube drain to achieve this has not been designed or studied in literature. Aim: To showcase an innovation using nebulizer and underwater sealed chest tube drain assembled for irrigation during laparoscopy and endoscopy procedures. Materials and methods: A prospective preliminary experimental study was conducted using a newly designed method of irrigation in laparoscopic and endoscopic surgeries performed from March 2021 to March 2022 in a tertiary center and a private hospital in South Southern, Nigeria. Ethical approval was obtained from the hospital ethics committee and informed consent was obtained from patients. The effectiveness of this new method was compared with standard irrigation machine as control. The patients were blocked into laparoscopy and colonoscopy procedures, respectively. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 26). Results: The results showed that the use of nebulizer underwater sealed chest tube drain assembly was very effective in laparoscopy and colonoscopy procedures. In three cases of fundoplication operations, five cases of cholecystectomies and 30 cases of hydro-jet insufflation colonoscopies were performed with good outcomes. Conclusion: This new novel method will serve a very good alternative irrigation method in laparoscopy and endoscopy procedures. It is currently being studied in other methods, such as hysteroscopy, cystoscopy, and therapeutic endoscopies. [ABSTRACT FROM AUTHOR]

The article focuses on a 1958 Ciba-sponsored symposium in London, discussing pH and blood gas measurement, particularly in relation to respiratory disorders during anesthesia, featuring contributions from experts like Poul Astrup and John Severinghaus, and highlighting the evolving technology and debates in the field.

Background: Recently, a non-commercial oxygenation laryngoscope was able to maintain apneic oxygenation during simulated intubation efforts. Since that prototype was 3 mm wider than a standard Macintosh laryngoscope blade, the intubation performance of this device may differ from standard blades. A new prototype of an oxygenation laryngoscope was developed, consisting of a standard-size Macintosh blade and a fixed oxygen supply line to the side. Actually, it is unclear at which point of this blade the oxygen supply line should end to facilitate the best possible oxygen supply for apneic oxygenation. Methods: In this simulation study using a standardized human airway manikin, the efficacy of apneic oxygenation by oxygen insufflation using standard and modified Macintosh blades was compared: a standard Macintosh blade without oxygen supply line as control, one with an additional oxygen supply line ending proximal near the handle, one with the line ending at the middle of the blade, and one with the line ending near the tip. A preoxygenated test lung was connected to an oximeter with a flow rate of 200ml/min, simulating oxygen consumption of a male adult, and to the trachea of an anatomically correctly shaped airway manikin. Apneic oxygenation was performed and oxygen content was measured over a 20-minutes observation period. Experiments were repeated five times for each laryngoscope blade. Results: Oxygen percentage in the test lung dropped from 100 ± 0% at the start of the experiment to 53 ± 1.5% in the room air control group (p < 0.001 compared to all other groups), and to 74 ± 2.5% in the proximal oxygen line group, whereas oxygen percentage remained at 100% in both the medium and distal oxygen line groups (p = 1 between these groups; p < 0.001 between all other groups). Conclusions: In this simulation study with a preoxygenated airway manikin, the use of a modified Macintosh laryngoscope blade with oxygen line attached at the tip or at the middle were able to maintain apneic oxygenation without measurable drop of oxygen content over 20 min. Proximal placement of the oxygen supply line still showed an advantage against room air, however it did not completely prevent room air from entering the airway. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: The abdominal insufflation and changes in endotracheal tube (ETT) cuff pressure due to creation of pneumoperitoneum and changes in patient positioning during laparoscopic abdominal surgeries have not been explored thoroughly. Aims and Objectives: The aim of our study was to see the changes in ETT cuff pressures during creation, maintenance, release of pneumoperitoneum, and during surgical positioning. Materials and Methods: A total of 60 patients were finally taken for study. Written informed consent was taken for participation in the study as well as consent for surgery. Inclusion criteria were patients of age above 30 years, American society of anesthesiology physical status 1 and 2, patients undergoing total laparoscopic hysterectomy requiring trendelenburg positioning. Exclusion criteria were patients with pre-existing pulmonary or cardiac disease, patients with preexisting vocal cord palsy, goitre or any other airway or thoracic pathology, pregnant or lactating females, BMI more than 25 or <18.5. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analyzed and compared. Results: Baseline cuff pressure after manual inflation was 28.85±11.4 cm H2O. Significant correlation was observed between change in cuff pressure and increase in peak airway pressure at the end of the surgery (P<0.05). Serial measurements of ETT cuff pressure, peak airway pressure, and ETCO2 were significantly increased compared to baseline (P<0.05). Conclusion: Pneumoperitoneum in Trendelenburg position increases ETT cuff pressure probably due to increase in airway pressure. Therefore, it seems advisable to include routine monitoring of ETT cuff pressure. Objective adjusted measurement of cuff pressure and airway pressures is recommended for such surgeries. [ABSTRACT FROM AUTHOR]

Background Anorectal function deteriorates with age. The diagnostic performance of the endoscopic pressure study integrated system (EPSIS), an endoscopic carbon dioxide (CO2) insufflation stress test of the lower esophageal sphincter has been previously evaluated as a diagnostic tool for gastroesophageal reflux disease. We aimed to evaluate the applicability of EPSIS in improving anorectal function. We hypothesized that EPSIS can be applied to the diagnosis of lower gastrointestinal tract disorders. Methods This was a pilot, single-center, retrospective study using prospectively collected data between December 2021 and March 2022. It was designed to evaluate the differences in EPSIS rectal pressure measurements between older (≥80 years) and younger (<80 years) patients. At the end of the screening colonoscopy, the colonoscope was fixed in a retroflex position. When bowel movement was observed, CO2 was insufflated to the point where gas leakage occurred through the anus. The measured maximum pressure was defined as EPSIS-rectal pressure max (EPSIS-RP max) and compared between the groups. Results Overall, 30 patients were included and examined. The median ages of the <80 and ≥80 years' groups were 53 (range: 27-79) and 82 (range: 80-94) years, respectively, with corresponding median measured EPSIS-RP max of 18.7 (range: 8.5-30.2) and 9.8 (range: 5.4-22.3) mmHg (P<0.001). Conclusions Measurement of maximum rectal pressure illustrates the age-related decline in physiological anorectal function. Future studies should consider a loading test using EPSIS to quantify the decline in anorectal function and use it as a routine tool for screening and adjunctive diagnosis of anorectal hypofunction. [ABSTRACT FROM AUTHOR]

Laparoscopic surgery (LS) is superior to conventional laparotomy due to its advantages, such as less trauma, early mobilization, minimal blood loss, less scarring, reduced postoperative pain, shorter postoperative recovery time and hospital stay, and lower mortality and morbidity. Significant hemodynamic, cardiopulmonary, and physiological changes occur in the systems due to increased intra-abdominal pressure and hypercarbia after carbon dioxide insufflation is applied for pneumoperitoneum (PP) during LS. The main goals in anesthesia management are understanding the primary pathophysiology, optimizing functional status and hemodynamics, and managing comorbidities. To minimize the effects and impacts of PP in patients who will undergo LS, as in every patient, comprehensive preoperative evaluation should be carried out by multidisciplinary approach that includes an anesthesiologist and surgeon. Our review emphasizes the importance of pathophysiological and systemic changes during LS performed by applying PP and summarizes the recovery and postoperative complications of anesthesia methods applied in clinical practice. [ABSTRACT FROM AUTHOR]

Background and Aims: Apnoeic oxygenation, although useful during elective intubations, has not shown consistent beneficial results during emergency intubations in critically ill patients. We aimed to study the effectiveness of adding apnoeic oxygenation to our routine practice of using facemask alone, in emergency laparotomy patients needing rapid sequence induction (RSI), for sustaining partial pressure of oxygen (PaO2). Material and Methods: Seventy-two patients undergoing RSI for emergency laparotomy were randomly allocated to either receive pre-oxygenation with 5 L/min of oxygen (O2) with a facemask (Group-FM) or apnoeic oxygenation with 10 L/min of O2 through a nasal catheter in addition to pre-oxygenation (Group-NC). Apnoea (90 s) was allowed from the removal of the facemask before the resumption of ventilation. Arterial blood gas analysis was done at the baseline, following pre-oxygenation and after 90 s of apnoea to study the PaO2 and partial pressure of carbon dioxide (PaCO2). The circuit O2 concentrations (fraction of inspired [FiO2] and end-tidal [EtO2]) were also noted to ensure a steady state of O2 uptake was reached. Results: The circuit O2 concentrations were 90 ± 4% in group FM and 93 ± 5% in Group-NC. The FiO2-EtO2 difference was 4% in both groups. During the 90 s apnoea following pre-oxygenation, there was a fall in the PaO2 by 38% in Group-FM and 12% in Group-NC (P = 0.000). Increase in PaCO2 was similar in both groups (Group-FM: 44 [range: 32–55] mmHg; Group-NC: 42 [range: 33–54] mmHg, P = 0.809). Conclusion: Apnoeic insufflation of O2 using a nasopharyngeal catheter along with facemask oxygenation is more effective in sustaining PaO2 for 90 s during RSI than facemask-only oxygenation in patients undergoing emergency laparotomy. [ABSTRACT FROM AUTHOR]

Background: The extra-cervical lateral route endoscopic thyroidectomy (LRET) approaches such as the trans-axillary, breast and axillo-breast approaches are proved to be safe, feasible, esthetic, highly effective. The inherent difficulty and long learning curve of these techniques prevents its widespread application. Methods: Benefiting from the experience of more than 5 years in LRET approaches with CO2 insufflation, the authors developed ten surgical key steps and a critical view of safety (CVS) for performing thyroid lobectomy via LRET approaches. A detailed description and a video of the surgical technique is provided. Results: Application of these structured key steps and CVS was feasible and effective in achieving thyroid lobectomy in all selected cases with unilateral goiter up to 8 cm, even in cases with thyroiditis or controlled toxic adenoma, without any adverse events and with shorter operative time than the non-structured surgical technique. Conclusion: The described ten key steps and CVS are conclusive, applicable, easy to learn. Our video could act as a guide for promoting the standardized, safe, and wide application of LRET techniques. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine ideal insufflation pressures during transanal minimally invasive surgery (TAMIS) in canine cadavers for rectal submucosal transection and incisional closure. ANIMALS 16 canine cadavers. PROCEDURES Cadavers were placed in lateral recumbency. Urinary catheters were placed to measure intra-abdominal pressure (IAP). A single access port was placed to establish a pneumorectum. Cadavers were placed in insufflation groups of 6 mmHg to 8 mmHg (group 1), 10 mmHg to 12 mmHg (group 2), or 14 mmHg to 16 mmHg (group 3). Defects in the rectal submucosa were created and closed with a unidirectional barbed suture. Duration for each procedure and subjective ease of identifying the transection plane and performing incisional closure were assessed. RESULTS The single access port was successfully placed in dogs weighing 22.7 kg to 48 kg. The ease of each step of the procedure was not influenced by the insufflation pressure. The median surgical duration for group 1 was 740 seconds (range = 564 to 951 seconds), 879 seconds (range = 678 to 991 seconds) for group 2, and 749 seconds (range = 630 to 1,244 seconds) for group 3 (P = .650). The insufflation pressure increased the IAP (P = .007). Perforation of the rectum happened in 2 cadavers in group 3. CLINICAL RELEVANCE The duration of each step of the procedure was not significantly influenced by insufflation pressure. Defining the dissection plane and performing resection was more challenging in the highest-pressure group. Rectal perforation occurred only with the 14 mmHg to 16 mmHg insufflation pressure. Single access port usage with TAMIS may provide a readily available, minimally invasive approach for the resection of rectal tumors in dogs. [ABSTRACT FROM AUTHOR]

Background and Aims: Increased intra-abdominal pressure (IAP) and carbon dioxide gas during pneumoperitoneum leads to various systemic changes involving cardiovascular, respiratory, and cerebral physiology. In our study, we aimed to investigate the effect of standard (13-15 mmHg) and low (6-8 mmHg) pressure pneumoperitoneum on optic nerve sheath diameter (ONSD) using ultrasound, which is a reflection of intracranial pressure (ICP). Patient hemodynamics, surgery duration and surgeons' comfort, and ease of performing surgery at low-pressure pneumoperitoneum were studied as secondary objectives. Materials and Methods: In this prospective double-blind randomized study, 75 patients of the American Society of Anesthesiologists physical status grades I and II, of both genders undergoing elective laparoscopic surgery, were allocated into two groups - S (standard IAP 13-15 mmHg) and L (low IAP 6-8 mmHg). ONSD acquired at different time points: before induction of anesthesia (T1), 5 min after intubation (T2), 5 min after the creation of pneumoperitoneum (T3), 5 min before desufflation (T4), and 5 min before extubation (T5). ONSD of 5 mm is taken as the cutoff value to correlate raised ICP. Continuous variables were analyzed by the Student's t-test, and categorical data were assessed by the Chi-square test. Results: There was a significant increase in ONSD with insufflation in both the groups; however, T3 is higher than the cutoff value (>5 mm) in Group S. The ONSD values at T1 (baseline) and at T2 (after intubation) were comparable between the groups, with P = 0.1855 and P = 0.8988, respectively. With pneumoperitoneum, the increase in ONSD (T3) is significantly higher in Group S than in Group L with P = 0.0022, attributing to the high IAP in Group S. Conclusion: Laparoscopic surgery with low-pressure pneumoperitoneum can be a safe approach, particularly in individuals at risk of raised ICP. [ABSTRACT FROM AUTHOR]