OBJECTIVE: To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients. METHODS: Ninety obese patients (BMI 30-39.9 kg/m RESULTS: The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T ( CONCLUSIONS Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.
Anesthesia, General ; Humans ; Insufflation ; Intubation, Intratracheal ; Masks ; Obesity

Central hypoventilation syndrome is a rare and fatal condition resulting from various central nervous system disorders that is characterized by a failure of automatic breathing. We report a case of central hypoventilation syndrome following posterior circulation stroke whose pulmonary function was improved by respiratory rehabilitation. A 59-year-old woman with a history of hemorrhagic stroke of the bilateral cerebellum was hospitalized due to pneumonia. A portable ventilator was applied via tracheostomy, recurrent episodes of apnea and hypercapnia impeded weaning. A respiratory rehabilitation program including chest wall range of motion exercise, air stacking exercise, neuromuscular electrical stimulation (NMES) on abdominal muscles, upper extremity ergometer, locomotor training, high-frequency chest wall oscillator, mechanical insufflation, and exsufflation was employed, as spirometry showed a severe restrictive pattern. A spontaneous breathing trial was started, and a portable ventilator was applied for 8 hours, only during nighttime, to prevent sudden apneic event. After 4 weeks of treatment, follow-up spirometry showed much improved respiratory parameters. This case suggests that respiratory rehabilitation can improve pulmonary function parameters and quality of life in central hypoventilation syndrome.
Abdominal Muscles ; Apnea ; Central Nervous System Diseases ; Cerebellum ; Electric Stimulation ; Female ; Follow-Up Studies ; Humans ; Hypercapnia ; Hypoventilation ; Insufflation ; Middle Aged ; Pneumonia ; Quality of Life ; Range of Motion, Articular ; Rehabilitation ; Respiration ; Respiratory Center ; Spirometry ; Stroke ; Thoracic Wall ; Tracheostomy ; Upper Extremity ; Ventilators, Mechanical ; Weaning

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.
Anesthesia ; Anesthesia, General ; Carbon Dioxide ; Endoscopy ; Esophageal Achalasia ; Hemodynamics ; Hemorrhage ; Incidence ; Insufflation ; Mediastinal Emphysema ; Patient Safety ; Pneumoperitoneum ; Pneumothorax ; Subcutaneous Emphysema

No abstract available.
Insufflation ; Sleep Apnea, Obstructive

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), although, associated with poor patient compliance. Conversely, high flow, humidified, temperature-regulated nasal insufflation of oxygen or air is well tolerated.CASE: We describe our experience of three patients with known or suspected moderate to severe OSA who were poorly compliant to CPAP therapy and received high flow nasal insufflation (HFNI) postoperatively. None had significant episodes of desaturation (SpO₂ < 95%) and all patients uniformly reported superior comfort levels than with the CPAP therapy. HFNI generates small amounts of positive end-expiratory pharyngeal pressure, increases inspiratory airflow and decreases dead space ventilation. Due to the open system, less difficulty with the patient-mask interface and improved patient comfort is experienced. These factors help prevent hypopnea and lead to enhanced sleep continuity.CONCLUSIONS: HFNI may be a promising alternative to CPAP therapy in the perioperative setting.
Continuous Positive Airway Pressure ; Humans ; Insufflation ; Oxygen ; Patient Compliance ; Sleep Apnea, Obstructive ; Ventilation

BACKGROUND: Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA Supreme™) in geriatric patients. METHODS: The subjects were American Society of Anesthesiologists physical status classification I–III geriatric (65–85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA Supreme™ group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. RESULTS: Insertion time was significantly shorter for the i-gel® than the LMA Supreme™ (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA Supreme™ (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA Supreme™ (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. CONCLUSIONS: Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA Supreme™ in geriatric patients.
Adult ; Aging ; Airway Management ; Anesthesia, General ; Classification ; Hemodynamics ; Humans ; Insufflation ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Prospective Studies ; Ventilation ; Ventilators, Mechanical

BACKGROUND: The trans-tracheal rapid insufflation of oxygen (TRIO) device is less commonly used and is an alternative to trans-tracheal jet ventilation for maintaining oxygenation in a “cannot intubate, cannot oxygenate” (CICO) scenario. CASE: We report the successful use of this device to maintain oxygenation after jet ventilator failure in a parturient who presented with the CICO scenario during the procedure for excision of laryngeal papilloma. CONCLUSIONS: A stepwise approach to the airway plan and preparation for an event of failure is essential for good materno-fetal outcomes. The TRIO device may result in inadequate ventilation that can lead to hypercarbia and respiratory acidosis. Hence, it should only be used as a temporizing measure before a definitive airway can be secured.
Acidosis, Respiratory ; Airway Management ; Airway Obstruction ; Anesthesia, Obstetrical ; High-Frequency Jet Ventilation ; Insufflation ; Oxygen ; Papilloma ; Ventilation ; Ventilators, Mechanical

BACKGROUND/AIMS: This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation). METHODS: Patients with body mass index (BMI) less than 18 kg/m2 or more than 30 kg/m2, or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation. RESULTS: The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (P < 0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (P < 0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups. CONCLUSIONS: Water insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI < 18 kg/m2 and the post-surgical group, but not in the group with BMI >30 kg/m2.
Body Mass Index ; Carbon Dioxide* ; Carbon* ; Colonoscopy* ; Humans ; Insufflation* ; Intubation ; Water*

No abstract available.
Carbon Dioxide* ; Carbon* ; Colonoscopes* ; Insufflation* ; Water*

PURPOSE: During a laparotomy, the peritoneum is exposed to the cold, dry ambient air of the operating room (20℃, 0%–5% relative humidity). The aim of this review is to determine whether the use of humidified and/or warmed CO2 in the intraperitoneal environment during open or laparoscopic operations influences postoperative outcomes. METHODS: A review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, OVID MEDLINE, Cochrane Central Register of Controlled Trials and Embase databases were searched for articles published between 1980 and 2016 (October). Comparative studies on humans or nonhuman animals that involved randomized controlled trials (RCTs) or prospective cohort studies were included. Both laparotomy and laparoscopic studies were included. The primary outcomes identified were peritoneal inflammation, core body temperature, and postoperative pain. RESULTS: The literature search identified 37 articles for analysis, including 30 RCTs, 7 prospective cohort studies, 23 human studies, and 14 animal studies. Four studies found that compared with warmed/humidified CO2, cold, dry CO2 resulted in significant peritoneal injury, with greater lymphocytic infiltration, higher proinflammatory cytokine levels and peritoneal adhesion formation. Seven of 15 human RCTs reported a significantly higher core body temperature in the warmed, humidified CO2 group than in the cold, dry CO2 group. Seven human RCTs found lower postoperative pain with the use of humidified, warmed CO2. CONCLUSION: While evidence supporting the benefits of using humidified and warmed CO2 can be found in the literature, a large human RCT is required to validate these findings.
Animals ; Body Temperature ; Carbon Dioxide ; Cohort Studies ; Humans ; Inflammation ; Insufflation* ; Laparotomy ; Operating Rooms ; Pain, Postoperative ; Peritoneum ; Pneumoperitoneum ; Prospective Studies ; Tissue Adhesions