Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whe...Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications.Methods:This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020.Forty children of the American Society of Anesthesiologists class I/II of ages 1–12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited.Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position.The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications.Results:The incidence of airway complications was 30%in the supine group and 20%in the lateral group(P=0.6641).Incidence of laryngospasm,immediate stridor,and excessive secretions were similar.Early stridor and oxygen desaturation were higher in the supine group(P=0.0374,P=0.0183 respectively).Interpretation:The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children.The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.展开更多
To the editor:A 10-year-old girl presented for cataract surgery under general anesthesia.The preanesthetic checkup was unremarkable.Preoperative investigations were normal including liver and renal function tests whic...To the editor:A 10-year-old girl presented for cataract surgery under general anesthesia.The preanesthetic checkup was unremarkable.Preoperative investigations were normal including liver and renal function tests which were ordered as the child seemed small and malnourished.A standard anesthesia technique was used with sevoflurane induction and maintenance with 33% oxygen in nitrous oxide,sevoflurane,fentanyl and vecuronium.展开更多
To the editor:Neuromuscular blocking drugs (NMBDs) are administered to facilitate surgical exposure and controlled ventilation. However, their use is associated with several complications, especially in the pediatric ...To the editor:Neuromuscular blocking drugs (NMBDs) are administered to facilitate surgical exposure and controlled ventilation. However, their use is associated with several complications, especially in the pediatric age group. Arnot-Smith and Smith analysed complications related to the use of NMBDs in anesthesia.1 Of 200000 patient safety incidents reported from 2006–2008, 17179 (8.8%) were classed as 'anesthetic', while 231 (0.1%) were attributed to the use/reversal of NMBDs1;of these 231 incidents related to the use/reversal of NMBDs, extravasation only occurred in four cases (1.7%).1 Extravasation is defined as the accidental injection/leakage of fluid into perivascular tissues, which reportedly occurs in 10%–30% of patients receiving intravenous infusions.展开更多
文摘Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications.Methods:This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020.Forty children of the American Society of Anesthesiologists class I/II of ages 1–12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited.Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position.The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications.Results:The incidence of airway complications was 30%in the supine group and 20%in the lateral group(P=0.6641).Incidence of laryngospasm,immediate stridor,and excessive secretions were similar.Early stridor and oxygen desaturation were higher in the supine group(P=0.0374,P=0.0183 respectively).Interpretation:The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children.The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.
文摘To the editor:A 10-year-old girl presented for cataract surgery under general anesthesia.The preanesthetic checkup was unremarkable.Preoperative investigations were normal including liver and renal function tests which were ordered as the child seemed small and malnourished.A standard anesthesia technique was used with sevoflurane induction and maintenance with 33% oxygen in nitrous oxide,sevoflurane,fentanyl and vecuronium.
文摘To the editor:Neuromuscular blocking drugs (NMBDs) are administered to facilitate surgical exposure and controlled ventilation. However, their use is associated with several complications, especially in the pediatric age group. Arnot-Smith and Smith analysed complications related to the use of NMBDs in anesthesia.1 Of 200000 patient safety incidents reported from 2006–2008, 17179 (8.8%) were classed as 'anesthetic', while 231 (0.1%) were attributed to the use/reversal of NMBDs1;of these 231 incidents related to the use/reversal of NMBDs, extravasation only occurred in four cases (1.7%).1 Extravasation is defined as the accidental injection/leakage of fluid into perivascular tissues, which reportedly occurs in 10%–30% of patients receiving intravenous infusions.
