Matilde Zaballos

Predicted end-tidal sevoflurane concentration for insertion of a Laryngeal Mask Supreme: a prospective observational study.

CONTEXT The single-use Laryngeal Mask Airway (LMA) Supreme is a new supraglottic airway device. It has been reported to be reliable and easy-to-use in clinical practice; however, the anaesthetic techniques for its insertion are not standardised. OBJECTIVES The purpose of this study was to determine the ED50 of end-tidal sevoflurane concentration for successful LMA Supreme insertion without the use of neuromuscular blockade. DESIGN A prospective observational study. SETTING A single tertiary care surgical centre. PATIENTS Thirty-one consecutive elective patients scheduled for minor elective surgery under general anaesthesia. INTERVENTION Patients were preoxygenated with 100% oxygen and anaesthetised using normal tidal volume inhalation of sevoflurane. The target sevoflurane concentration was determined using a modified Dixons ‘up-and-down’ method (starting at 2.5% with 0.5% as the step size). After the predetermined end-tidal concentration had been established and maintained for 10 min, LMA Supreme insertion was attempted. MAIN OUTCOME MEASURE The main outcome measure was the patients response to LMA Supreme insertion, classified as either ‘movement’ or ‘no movement’. The mean of the concentrations of seven cross-overs from ‘movement’ to ‘no movement’ was used to estimate the ED50. RESULTS The estimated sevoflurane concentration for successful LMA Supreme insertion in 50% of adults was 3.03 ± 0.75% (95% confidence interval 2.3 to 3.7%). The values of the ET50 and ET95 obtained by logistic regression were 2.83 and 5.30%, respectively. CONCLUSION Sevoflurane alone can provide acceptable conditions for insertion of the LMA Supreme in adults, at an estimated minimum alveolar anaesthetic concentration of 3% with minimal adverse effects.

Preoperative smoking cessation counseling activities of anesthesiologists: a cross-sectional study

BackgroundSmokers undergoing surgery are at a higher risk of complications than non-smokers. Preoperative evaluation by an anesthesiologist could provide an excellent opportunity to promote smoking cessation. Previous surveys of anesthesiologists have found that self-reported smoking cessation counseling rates have room for improvement, but no study has surveyed patients to obtain more accurate estimates.MethodsA single-center study was conducted from January 2010 to June 2010 in a tertiary teaching hospital. A telephone survey was conducted, which included all adult cigarette smokers who visited the preoperative anesthesia clinic. The survey recorded anesthesiologist-delivered interventions to help patients quit smoking before surgery. At the end of the study period, the self-reported smoking cessation counseling of the anesthesiologist was evaluated by questionnaire.ResultsOne thousand one hundred and sixty-five patients were evaluated, of which 217 were current smokers with a median pack-year of 15 (interquartile range 5.25–30.00) and 34% were scheduled to undergo major surgery. With regard to preoperative interventions, most anesthesiologists (85%) asked about smoking status, although only 31% advised patients about the health risks of smoking and 23% advised patients to quit before surgery. Provision of assistance to help patients quit was provided in 3% of cases. By contrast, 75% of anesthesiologists stated that they frequently or almost always advised patients about the health risks of smoking.ConclusionsThis study shows significant discrepancies between direct patient surveys of preoperative smoking cessation counseling activities by anesthesiologists and the self-reported perceptions of the anesthesiologists. Future studies are urgently needed to evaluate the provision of educational materials and other interventions to improve smoking cessation counseling rates among anesthesiologists and to narrow these discrepancies.

Awake insertion of a Laryngeal Mask Airway-Proseal™ as alternative to awake fiberoptic intubation in management of anticipated difficult airway in ambulatory surgery

BACKGROUND AND OBJECTIVES The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery. CASE REPORT A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation. She reported emotional distress with the previous experience and declined this approach. In view of the previous experience, an awake airway control with a Laryngeal Mask Airway Proseal™ was planned after explaining and reassuring the patient. After adequate topicalisation, a size 4 Laryngeal Mask Airway Proseal™ was successfully inserted after two attempts, and their patency was confirmed by capnography. Anesthesia was induced intravenously and the surgery was uneventful. CONCLUSION We describe a feasible alternative strategy to awake intubation in a patient with known difficult airway undergoing ambulatory surgery. In this specific clinical situation, if tracheal intubation is deemed unnecessary, awake supraglottic airway might allow adequate ventilation and their use should be considered.

Can anesthesiologists trust anesthesia depth monitors

acute lymphocytic leukemia who required central venous access to deliver chemotherapy was scheduled for venous port catheter placement under general anesthesia. We attempted catheterization of the left subclavian vein under ultrasonographic guidance, but we failed on three consecutive attempts. Next we attempted the catheterization on the right subclavian vein, successfully puncturing it on our second attempt. We placed the catheter using the Seldinger technique and subcutaneously placed a 6.5F venous port. We experienced no complications during the procedure. When the patient emerged from anesthesia and opened his eyes, we noticed a right-sided ptosis and accompanying myosis (right/left eye diameter: 2.5 mm/4 mm), leading us to diagnose Horner syndrome. His symptoms lasted for 2 wk and completely resolved.

Multimodal prophylaxis of postoperative nausea and vomiting in day-case anaesthesia: A-47

domised study were 99 women ASA I–III undergoing ambulatory laparoscopic gynaecological surgery under general anaesthesia received during the induction: Group D (n 54): 4 mg dexamethasone, Group O (n 42): 4 mg ondansetron. Patients suffering of diabetes or morbid obesity were considered non eligible. Both groups were comparable for age, weight, smokers, surgery’s duration, other risk factors for post-operative nausea and VAS of postoperative pain. T-test was used to compare quantitative variables, Fisher’s Exact test for qualitative variables, variables found significant at a level of p 0.2 were considered in the multivariate model (logistic regression). Variables with a p-value 0.05 were considered significant. Results: We did not found significative differences in the global incidence of nausea, vomiting and the need of anti-emetic rescue in between the two groups: nausea D 27%, O 36%, p 0.38; vomiting D 11%, O 14%, p 0.75 and need of rescue D 16%, O 21%, p 0.61. No differences were found when the incidence of nausea, vomiting and need of rescue was analysed within the following time intervals: 1 hour from surgery, between 1 and 6 hours and between 6 hours after surgery and discharge (data not shown). Conclusion: In this randomised study, we have not found differences between 4 mg of ondansetron and 4 mg of dexamethasone in the incidence of nausea, vomiting or the needs of anti-emetic rescue. Therefore dexamethasone should be recommended as the most cost-effective alternative.