Bridging the gap: understanding Belgian anesthesiologists' proficiency and training demands in gastric point-of-care ultrasound, a case-based survey.

BACKGROUND: Pulmonary aspiration syndrome remains a significant complication of general anesthesia, particularly in unfasted patients. Gastric point-of-care ultrasound (POCUS) allows for both qualitative and quantitative assessment of gastric content, providing a safe and reliable method to assess gastric emptying and reduce the risk of aspiration during general anesthesia. METHODS: The survey was distributed to Belgian certified anesthesiologists and trainees between April 2020 and June 2021. Participants received a simulated clinical case of a patient at risk of gastric aspiration, created and approved by two certified anesthesiologists trained to perform gastric POCUS. The objectives of this study were to assess recognition of high-risk clinical situations for gastric aspiration, awareness of the gastric POCUS and its indications, and knowledge of the technical and practical conditions of the procedure among respondents trained in the technique. Furthermore, the study assessed the state of training in gastric POCUS, the desire for education, and the practical availability of ultrasound equipment. The survey used conditional branching to ensure unbiased responses to POCUS-related questions. It included multiple-choice questions, quantitative variables, and 5-point Likert scales. The margin of error was calculated using Daniel's formula, corrected for a finite population. RESULTS: The survey was conducted among 323 anesthesiologists. Only 20.8% (27) recognized the risk of a full stomach based on the patient's history. Anesthesiologists who recognized the indication for gastric POCUS and were trained in the procedure demonstrated good recall of the practical conditions for performing the procedure and interpreting the results. Only 13.08% (31) of all respondents had received training in gastric POCUS, while 72.57% (172) expressed interest in future training. Furthermore, 80.17% (190) of participants had access to adequate ultrasound equipment and 78.90% (187) supported teaching gastric POCUS to anesthesia trainees. CONCLUSIONS: This survey offers insight into the epidemiology, clinical recognition, knowledge, and utilization of gastric POCUS among Belgian anesthesia professionals. The results emphasize the significance of proper equipment and training to ensure the safe and effective implementation of gastric POCUS in anesthesia practice. Additional efforts should focus on improving training and promoting the integration of gastric POCUS into daily clinical practice.

Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material.

BACKGROUND: To perform step-by-step analysis of the different factors (material, anesthesia technique, human, and location) that led to major pneumothorax during an infrequent pediatric cardiac MRI and to prevent its occurrence in the future. Anesthesia equipment used in a remote location is often different than those in operating rooms. For magnetic resonance imaging (MRI), ventilation devices and monitors must be compatible with the magnetic fields. During cardiac MRI numerous apneas are required and, visual contact with the patient is limited for clinical evaluation. Anesthesia-related barotrauma and pneumothorax are rare in children and the first symptoms can be masked. CASE PRESENTATION: A 3-year-old boy with atrial septal defect (ASD) and suspicious partial anomalous pulmonary venous return was anesthetized and intubated to perform a follow up with MRI. Sevoflurane maintenance and ventilation were performed using a circular CO2 absorber device, co-axial circuit, and 500 mL pediatric silicone balloon. Apneas were facilitated by Alfentanyl boluses and hyperventilation. A few moderated desaturations occurred during the imaging sequences without hemodynamic changes. At the end of the MRI, facial subcutaneous emphysema was observed by swollen eyelids and crackling snow neck palpation. A complete left pneumothorax was diagnosed by auscultation, sonography examination, and chest radiograph. Pneumo-mediastinum, -pericardium and -peritoneum were present. A chest drain was placed, and the child was extubated and transferred to the pediatric intensive care unit (PICU). Despite the anesthesiologist's belief that PEEP was minimal, critical analysis revealed that PEEP was maintained at a high level throughout anesthesia. After the initial barotrauma, repeated exposure to high pressure led to the diffusion of air from the pleura to subcutaneous tissues and mediastinal and peritoneal cavities. Equipment check revealed a functional circular circuit; however, the plastic adjustable pressure-limiting valve (APL) closed within the last 30° rotation. The balloon was found to be more rigid and demonstrated significantly reduced compliance. CONCLUSIONS: Anesthetists require proficiency is using equipment in non-OR locations and this equipment must be properly maintained and checked for malfunctions. Controlling the human factor risks by implementing checklists, formations, and alarms allows us to reduce errors. The number of pediatric anesthesia performed routinely appeared to be essential for limiting risks and reporting our mistakes will be a benefit for all who care about patients.

Innovative Approach to Difficult Airway Management: Utilizing the Cook® Airway Exchange Catheter for Double-Lumen Tube Intubation.

BACKGROUND The Cook® Airway ExchangeCatheter (Cook® AEC, Cook Group Incorporated, Bloomington, Indiana, USA) is an 83-cm-long graduated hollow tube with an external diameter of 11, 14, or 19 French, commonly used for tracheal tube replacement. Although this application is reliable in the exchange of single-lumen tubes, the failure rate markedly rises during the exchange from a single-lumen to a double-lumen endotracheal tube. It is also often used as a bridge to extubation in patients with difficult airways and for oxygenation support applications. CASE REPORT We describe the case of a 58-year-old patient with unexpected difficult airway management. He was scheduled to undergo a minimally invasive hybrid esophagectomy (laparoscopic abdominal stage followed by an open right thoracotomy, requiring one-lung ventilation with a double-lumen tube). After the laparoscopic abdominal stage, performed with a single-lumen endotracheal tube, we exchanged it for a double-lumen endotracheal tube. After several unsuccessful exchanges with a Cook® Airway Exchange Catheter due to the flexibility of the exchange catheter, we decided to use the exchange catheter as a method to maintain adequate ventilation while using it as a target to facilitate tracheal intubation alongside it, using a videolaryngoscope. CONCLUSIONS This case report discusses an unusual use of the Cook® Airway ExchangeCatheter during videolaryngoscopic double-lumen endotracheal tube (DLT) intubation. It reviews previously documented uses in the literature, while highlighting the possibility of failure during tube exchange. It also highlights its value as a support for oxygenation and ventilation during difficult intubation attempts.

[Cancer pain therapy: beyond conventional pharmacological approaches]. / Traitement de la douleur cancéreuse : au-delà des approches médicamenteuses conventionnelles.

Pain management in oncology is evolving progressively thanks to integrative approaches. In accordance with the type of pain and patient specifics, treatment possibilities are thus multiplied by combining conventional pharmacology, interventional approaches, physical and psychological treatments as well as complementary medicines, in a holistic perspective. International Societies Guidelines and scientific literature lend their support to such treatment plans. This article covers a number of interventional treatments and complementary options that are available. Their relevance is all the more important in view of the necessity to limit secondary effects and long-term opioids, especially in cancer survivors.

La prise en charge de la douleur en oncologie s'enrichit progressivement grâce à une approche intégrative. Celle-ci permet d'élargir la palette des outils thérapeutiques du praticien en combinant, selon les caractéristiques de la douleur et les spécificités du patient, les approches conventionnelles et complémentaires dans une vision holistique du patient. Les recommandations des sociétés internationales et la littérature scientifique s'étayent dans cette direction. Cet article couvre une partie des thérapies interventionnelles et des options complémentaires possibles. Leur pertinence est d'autant plus grande dans l'optique de limiter les effets secondaires des traitements médicamenteux et les opioïdes au long cours, prioritairement chez les patients en rémission ou avec une maladie contrôlée.