Evaluation and control of waste anesthetic gas in the postanesthesia care unit within patient and caregiver breathing zones.

This study (NCT02428413) evaluated waste anesthetic gas (WAG) in the postanesthesia care unit (PACU) and assessed the utility of the ISO-Gard® mask in reducing nursing exposure to WAG. We hypothesized that WAG levels in the patient's breathing zone upon recovery would exceed the recommended levels, leading to increased exposure of the PACU nurses, with use of the ISO-Gard mask limiting this exposure. A total of 125 adult patients were recruited to participate. Patients were randomized to receive the standard oxygen delivery mask or the ISO-Gard face mask postoperatively. Continuous particulate concentrations were measured using infrared spectrophotometers placed within the patients' and nurses' 6-inch breathing zone. Maximum WAG measurements were obtained every 30 seconds, and the duration of maximum WAG >2 ppm and its proportion relative to the total collection period were calculated. We observed a statistically significant difference in desflurane duration and proportion of maximum WAG >2 ppm in both patient and PACU nurse breathing zones. Therefore, patients and PACU nurses using routine care were exposed to WAG levels >2 ppm during the 1-hour postoperative period, and the ISO-Gard mask effectively reduced the amount of WAG detected in the immediate 1-hour postoperative recovery phase.

Subglottic perioperative airway-tube inflation via randomized evaluation with variable syringe size (Spair-Tire) study.

INTRODUCTION: Risks of endotracheal tube cuff (ETTC) over inflation must be balanced with the need to achieve a minimum pressure of 20 cm H2 O. Methods have been developed to estimate adequate ETTC pressurization but do not provide accurate endotracheal tube cuff pressure (ETCP) measurements. Hence, different sized syringes may play a role in determining ETCP. OBJECTIVES: Determine optimal syringe size for recommended ETCP. METHODS: Two hundred patients were randomized to use of either a 10-mL syringe (standard syringe) or a 5-mL syringe (study group) for ETTC inflation. Following the insertion of the endotracheal tube, the ETTC was inflated per the attending anesthesiologist. Within 10 minutes of intubation, ETCP was measured with a hospital-provided manometer. RESULTS: The percentage of in range cuff pressures for the 5-mL group was 10.53% and 6.78% for the 10-mL group. 84.21% (n = 64) of the study group and 91.53% (n = 54) of the control group had cuff pressures exceeding 30 cmH2 O. Although our study did not demonstrate that syringe size was predictive of ideal cuff pressure ranges, the average cuff pressure for the 5-mL group was 55.8 cm H2 O versus 68.8 cm H2 O in the 10-mL group. CONCLUSION: Although both 5- and 10-mL syringes resulted in elevated cuff pressures after intubation, 5-mL syringes resulted in a lower degree of elevation. Use of a 5-mL syringe should be considered when inflating the endotracheal cuff to possibly reduce patient harm secondary to elevated cuff pressures. Further studies assessing smaller syringe sizes to reduce cuff pressures are warranted.

Malignant Hyperthermia: Report of Two Cases with a Neglected Complication in Cardiac Surgery.

Malignant hyperthermia (MH) can develop after contact with volatile anesthetics (halothane, enflurane, isoflurane, sevoflurane, and desflurane) as well as succinylcholine and cause hypermetabolism during anesthesia, which is associated with high mortality when untreated. Early diagnosis and treatment could be life-saving. During cardiac surgery, hypothermia and cardiopulmonary bypass make the diagnosis of MH extremely challenging compared with other settings such as general surgery. We herein report 2 cases of MH, graded as "very likely" or "almost certain" based on the MH clinical grading scale. A 14-month-old infant and a 53-year-old male underwent surgery for severe pulmonary valve stenosis and mitral valve replacement, respectively. Both of them were extubated on the operation day, but they deteriorated with the development of high-grade fever, hypotension, renal failure, and acidosis. The first case had muscle spasms. Unfortunately, the delayed symptoms of MH in the early postoperative course were not diagnosed in these 2 cases, which caused permanent neurologic damage in the first case and death in the second one. However, the infant was discharged from the hospital after 2 months.