Enhanced recovery after surgery: comes out to the Sun.

ERAS programs aim to reduce the length of hospital stays and lower costs, and minimize the risk of postoperative complications and readmissions while enhancing the overall patient experience. BMC Anesthesiology has initiated a new collection on ERAS, urging investigators to conduct large-scale, high-quality studies that address the existing knowledge gap.

New Devices, Innovative Technologies, and Non-Standard Techniques for Airway Management: A Narrative Review.

A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All techniques are susceptible to failure. Therefore, it is necessary to have and know the greatest number of alternatives to treat even the most challenging airway successfully. The aim of this narrative review is to describe some new devices, such as video laryngeal masks, articulated stylets, and non-standard techniques, for laryngeal mask insertion and endotracheal intubation that are not applied in daily practice, but that could be highly effective in overcoming a difficulty related to airway management. Artificial intelligence and 3D technology for airway management are also discussed.

[Internal carotid artery dissection after laparoscopic surgery]. / Dissecção da artéria carótida interna após cirurgia laparoscópica.

Headache is a common symptom in the postoperative period and may be attributable to, dehydration, sleep deprivation, intentional or inadvertent dural puncture during a neuraxial anesthesia technique, from an inhaled anesthetic agent, or from specific surgical procedures, among other etiologies. However, more serious, uncommon and life-threatening conditions as carotid artery dissection can be associated with severe neurologic sequelae in otherwise young, healthy patients. For these reasons, clinicians involved with postoperative patients should be familiar with the presentation and management strategies for this complication.

Anesthetic management of an infant with giant abdominal neuroblastoma.

Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.

[Anesthetic management of an infant with giant abdominal neuroblastoma]. / Manejo anestésico de criança com neuroblastoma abdominal gigante.

Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.

Comparison of sevoflurane administered through a face mask versus rectal thiopental sodium in children undergoing magnetic resonance imaging.

OBJECTIVE: Sevoflurane (S) and thiopental sodium (T) are commonly used to produce sedation for routine MRI procedures. However, to date there have been no comparative studies evaluating both techniques. We herein present the firt study comparing S and T techniques for pediatric sedation in MRI procedures. MATERIALS AND METHODS: 21 children, aged from 3 months to 6 years, scheduled for MRI were randomly assigned to either S or T group. Sedation performed under spontaneous respiration was induced with inspired 1-8% S in oxigen by face mask connected to a Mapleson C circuit or T (25 mg/kg) administered in distal rectum by cannula. The observed parameters included: time for induction, MRI time, first movement activity postprocedure and recovery time; MRI pauses from patient movement; technique failure, quality of the study, emergence agitation, critical events; and parental and radiologist satisfaction. RESULTS: S compared with T showed significantly shorter anesthesia induction time (1.93 ± 0.7 versus 13.5 ± 2.6 min), first movement time (3.38 ± 1.2 versus 5.9 ± 2.1 min), recovery time (6.8 ± 1.6 versus 10.14 ± 3.3 min), and discharge MRI time (27.83 ± 5.1 versus 47.5 ± 8.7 min). There were fewer pauses during MRI from patient movement in S versus T (0 versus 3). The radiologists reported good quality and satisfaction scores in both groups. There were less behavioral disturbances in T group compared with S group (1 versus 3). There were no critical events in either group. There were no differences in parental satisfaction in both groups. CONCLUSIONS: Sevoflurane shortens the induction and recovery time, enabling earlier discharge. Sevoflurane and rectal thiopental sodium protocols are safe and effective, providing adequate conditions for MRI in pediatric outpatients, although rectal thiopental is more unpredictable.

[A randomised crossover trial comparing the Airtraq(®) NT, McGrath(®) MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin]. / Estudo cruzado e randômico comparando os laringoscópios Airtraq(®) NT, McGrath(®) MAC e Macintosh para intubação nasotraqueal em simulação de via aérea fácil e difícil em manequim.

OBJECTIVE: Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS: Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS: Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p<0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p<0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p<0.001). CONCLUSION: In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.

A randomised crossover trial comparing the Airtraq(®) NT, McGrath(®) MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin.

OBJECTIVE: Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS: Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS: Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p<0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p<0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p<0.001). CONCLUSION: In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.