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Weaning from Mechanical Ventilation
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Recent efforts have focused on processes for caring for the patient after extubation to prevent reintubation. The use of non-invasive ventilation as a rescue modality in patients with respiratory failure following extubation fails to prevent reintubation and is associated with increased mortality [6]. However, extubation directly to non-invasive ventilation before any failure has occurred has been studied, and for patients with chronic obstructive lung diseases demonstrated a decrease in the rates of post-extubation respiratory failure and 90-day mortality [7]. More recently, extubation directly to a high-flow nasal cannula for patients with a high risk of post-extubation respiratory failure was found to be effective in preventing respiratory failure and in reducing the rate of reintubation [8].
Airway Surgery
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
At the end of surgery the larynx is inspected and the airway suctioned under direct vision. Extubation is performed in the left lateral position with the head positioned to drain blood and secretions away from the larynx.
Clinical Workflows Supported by Patient Care Device Data
Published in John R. Zaleski, Clinical Surveillance, 2020
In the third phase, the patient is usually breathing spontaneously. The patient is fully re-warmed and the mechanical ventilator is providing oxygen and pressure support in this phase. The patient’s blood chemistry will be re-evaluated through further metabolic panels, and any evidence of adverse events will be assessed (e.g.: chest-tube drainage, rapid breathing, circulatory and neurological issues, etc.). The patient will be evaluated to determine the viability for endotracheal tube extubation. Prior to extubation, a chest X-ray may be ordered to verify that the lungs are clear.
Comparison between combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery
Published in Egyptian Journal of Anaesthesia, 2023
Moustafa Atef Moustafa Hamouda, Nahed E. Salama, Samia A. Hassan, Eman M. Aboseif, Rehab A. Abdelrazik
After steady-state anesthesia in both groups was obtained, but still the ACS>3, an additional dose of fentanyl (1 µg/kg) was given once suspected intraoperative pain. Cis-atracurium byselate (0.15 mg/kg) was given at 30 minutes intervals to maintain muscle relaxation. Bradycardia (heart rate < 50 beats/min) was treated with atropine (0.01–0.02 mg/kg). When severe hypotension occurred (MAP < 65 mmHg), a fluid challenge (lactated Ringer’s solution 3–4 ml/kg) and intravenous ephedrine (Initial dose: 0.05–0.1 mg/kg IV bolus, additional boluses were administered as needed, not to exceed a total dosage of 50 mg). At the end of surgery, the oropharyngeal pack was removed, dexmedetomidine infusion was stopped, sevoflurane was discontinued. Residual neuromuscular block was antagonized with neostigmine 0.05 mg/kg and atropine sulphate 0.02 mg/kg. Extubation was done only when the patients became fully awake (spontaneous eye opening, obeying verbal command and or tube localization), with satisfactory muscle power to support spontaneous regular ventilation with full tidal volume. In the postoperative settings, all patients were given a standard analgesic regimen with 1 gm paracetamol/8 h, patients with VAS score>3 at any point were given Ketorolac (30 mg) as a rescue analgesic by intravenous infusion with maximum dose 120 mg/day.
Effects of high-flow nasal oxygen cannula versus other noninvasive ventilation in extubated patients: a systematic review and meta-analysis of randomized controlled trials
Published in Expert Review of Respiratory Medicine, 2022
Kaiyuan Guo, Gang Liu, Wei Wang, Guancheng Guo, Qi Liu
For patients who have received mechanical ventilation, extubation is an important milestone in recovery; however, this procedure also causes patients to face the related risks of complications, extubation failure, and worsened prognosis. The causes of extubation failure mainly include vocal cord dysfunction, laryngospasm, laryngeal edema, and airway trauma, which affect the upper-airway patency [31]. Additionally, extubation failure could also be caused by excessive airway secretions, reduced ability to protect the airway, aspiration, encephalopathy and residual effects of sedative or neuromuscular blockade [31]. To prevent these outcomes and increase the success rate of extubation, the modalities of COT, HFNC, and NIV are commonly used to support breathing [32]. Although COT does not provide respiratory support, it is advantageous in patients without postoperative respiratory failure for prophylactic use [10]. As for the focus of this study, the strengths of HFNC and NIV might manifest mainly for critically ill patients, partially because of the pressure support effect. The air flow of HFNC meets the resistance of the nasal cavity, which can produce a positive pressure effect of about 3 cmH2O during the whole respiratory cycle, the level of pressure depends on the inspiratory flow [33]. The difference is that NIV can offer different levels of positive pressure support according to the patient’s needs. As a result, the respiratory support effect of HFNC cannot be greater than that of NIV.
Evaluation of unilateral ultrasound guided paravertebral block for perioperative analgesia in cancer patients undergoing lower limb sparing surgeries: A prospective randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2021
Yasmen F. Mohamed, Sayed M. Abed, Tamer M. Khair, Ahmed Abdalla Mohamed, Enas Samir, Walaa Y. Elsabeeny
In both groups, one reading of mean arterial pressure and heart rate were taken before induction of general anesthesia and were defined as baseline readings and then were recorded intraoperatively at 15-min intervals. Additional bolus doses of fentanyl 0.5 μg/kg were given when the mean arterial blood pressure or heart rate rose above 20% of baseline levels. Hypotension, which was diagnosed with drop of blood pressure more than 20% of baseline reading, was treated with 0.9% normal saline and/or 5 mg ephedrine in incremental doses in order to maintain mean blood pressure above 70 mmHg. Ringer acetate was infused in order to replace their fluid deficit, maintenance, and losses. Extubation was performed at the end of surgery after reversing of residual neuromuscular block and complete recovery of airway reflexes. Patients were transferred to the post anesthesia care unit (PACU) room then to the ward. Heart rate, mean arterial blood pressure and VAS scores were recorded on arrival to PACU and at 2, 4, 6, 12, 18, and 24 h postoperatively. In the first 24 hours postoperatively, all patients received multimodal analgesia using paracetamol 1 gm IV every 8 hours, ketorolac 30 mg was given, in addition to a bolus of 3 mg morphine if VAS ≥ 4. The total amount of morphine given in 24 h was recorded in the two groups. Patients in Group P were observed for any complications as hematoma, accidental nerve injury, inadvertent epidural injection and paravertebral muscle spasm. Side effects such as nausea, vomiting, hypotension, or bradycardia were recorded.