Extubation in the Operating Room After Transapical Transcatheter Aortic Valve Implantation Safely Improves Time-Related Outcomes and Lowers Costs: A Propensity Score-Matched Analysis.

OBJECTIVE: The experience of safe extubation in the operating room (OR) after transcatheter aortic valve implantation (TAVI) procedure remains not well established. The authors conducted this study to assess the effect of OR extubation in comparison with extubation in the intensive care unit (ICU) on the outcomes and cost in patients undergoing transapical-TAVI. DESIGN: A propensity score-matched analysis. SETTING: A single major urban teaching and university hospital. PARTICIPANTS: A total of 266 patients undergoing transapical TAVI under general anesthesia between June 2015 and March 2020. INTERVENTIONS: Propensity matching on pre- and intraoperative variables was used to identify 99 patients undergoing extubation in the OR versus 72 undergoing extubation in the ICU for outcome analysis. MEASUREMENTS AND MAIN RESULTS: After matching, extubation in the OR showed significant reductions of length of stay (LOS) in ICU (38.8 ± 17.4 v 58.0 ± 70.0 h, difference -19.2, 95% confidence interval [CI] -35.7 to -2.7, p = 0.009) and postoperative LOS in hospital (7.1 ± 3.9 v 10.1 ± 4.6 d, difference -3.0, 95% CI -4.3 to -1.7, p < 0.0001) compared with ICU extubation, but did not significantly affect the composite incidence of any postoperative complications (46.5% [46 of 99] v 52.8% [38 of 72], difference -6.3%, 95% CI -21.5 to 8.9, p = 0.415). Also, extubation in the OR led to significant reduction of total hospital cost compared with extubation in the ICU (¥303.5 ± 17.3 v ¥329.9 ± 52.3 thousand, difference -26.2, 95% CI -38.8 to -13.7, p < 0.0001). CONCLUSIONS: The current study provided evidence that extubation in the OR could be performed safely without increases in morbidity, mortality, or reintubation rate and could provide cost-effective outcome benefits in patients undergoing transapical-TAVI.

Pulmonary Edema After Intracranial Aneurysm Clipping in Kyphosis: A Case Report.

Introduction: A 56-year-old female patient was admitted to the hospital for "10+days of right eye droop and 1 day of aggravation". After admission, the physical examination found that the patient had severe scoliosis. 3D reconstruction and enhanced CT scan of the head vessels showed that the right internal carotid artery C6 aneurysms were clipped under general anesthesia. After the operation, the patient had increased airway pressure, with a large number of pink foam sputum attracted from the trachea catheter, and the lungs were scattered with moist rales during auscultation, After the treatment of anti-heart failure, the patient returned to the ICU through the trachea catheter. Eight hours later, the trachea catheter was pulled out and the patient was released from the ventilator. The symptoms were relieved on the fifth day after the operation. This case report describes the perioperative management of intracranial aneurysm with severe scoliosis. After strict monitoring and timely treatment during the perioperative period, the patient turned from crisis to safety, providing some reference for colleagues who encounter such patients in the future. Conclusion: In patients with scoliosis, due to long-term compression of the thorax, pulmonary restrictive ventilation dysfunction, small airway function and diffusion function are reduced, and cardiac function is decreased. Therefore, during the operation of intracranial aneurysms, fluid infusion should be careful, and volume monitoring should be done at all times to maintain the effective circulating blood volume of the body and prevent the aggravation of cardiac insufficiency and pulmonary edema.

A randomized trial to assess the effect of cricoid displacing maneuver on the success rate of blind placement of double-lumen tube and Univent bronchial blocker.

BACKGROUND: Double lumen tube (DLT) and Univent are two commonly used lung isolation devices that often require bronchoscopy assistance. In order to facilitate blind placement for situations where bronchoscopy was unavailable, the cricoid displacing maneuver (CDM) was adopted. This study was designed to explore whether the CDM could improve the successful blind placement rate in left lung isolation esophageal surgeries. METHODS: 120 ASA 1-3 patients who received left lung isolation esophageal surgeries from October 2014 to February 2016 and October 2018 to January 2020 were enrolled in this single-centered prospective assessorblinded randomized controlled trial. After anesthesia induction, patients were intubated either with DLT or Univent by applying the CDM, and the position of devices was checked by bronchoscopy. After turning into the right decubitus position, the devices were pulled back to the trachea, and placement was conducted once again. Successful placement rate for the first attempt, time needed for initial placement, malposition and reposition times by bronchoscopy during surgery, bronchus injury score, rank of lung isolation and postoperative anesthesia-related complications were recorded. RESULTS: At supine position, the successful placement rates for the first attempt of DLT-CDM, DLTcontrol, Univent-CDM and Univent-Control were 100%, 76.7%, 96.7% and 66.7% respectively (DLT: P=0.016; Univent: P=0.003) while at right decubitus position were 86.7%, 66.7%, 93.3% and 66.7% (DLT: P=0.067; Univent: P=0.010). There was no significant difference in the time needed for successful intubation and no severe complications. CONCLUSIONS: The current study provided evidence that the CDM is an effective and safe blind endobronchial placement technique for left DLT and Univent. We suggest that CDM could be applied to the endobronchial placement of left DLT and Univent.