Background: For several decades now, the use of uncuffed endotracheal tube (ETT) is the gold standard in providing airway and ventilatory support to children under anesthesia. However, there has been a change in focus from the application of uncuffed ETT to cuffed ETT among children, and this matter has been debated for years. In fact, several studies have shown that even across and within countries, the attitudes and practices of anesthesiologists on the use of types of endotracheal tubes differed. Objective: To describe the current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed ETT for children. Methods: A systematic review of observational studies on the current attitudes and practices of pediatric anesthesiologists regarding the use of cuffed and uncuffed ETT was conducted from May to November 2020. Cochrane reviews, Medline, Pubmed, and EMBASE were searched and yielded five relevant studies. Results: The use of cuffed ETT ranged between 11%-61% in the included studies and all reported that there were no consensus or standard on whether cuffed or uncuffed ETT was better. Reported factors for cuffed ETT use included: 1) Personal choice, 2) Department protocol, 3) Availability of resources, and 4) Specific conditions such as obesity, planned or emergency procedure, and reduced lung compliance. In terms of ETT size, reported criteria were: 1) Use of a formula, 2) Use of abacus/calculator, and 3) In relation to the fifth finger's width. Conclusions The current systematic review demonstrated that there is wide variation in current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed endotracheal tubes in children. Likewise, factors affecting choice of ETT and criteria for selection varied in the published literature. The results of this systematic review highlight the need for a standard guideline to help clinicians choose if cuffed or uncuffed ETT is better in certain scenarios and to help them decide in selecting the most appropriate ETT size.
Anesthesiology

An increasing number of neurological conditions may be treated with high-intensity focused ultrasound (HIFU), among which is geared towards the control of tremors as seen in patients with Parkinson’s Disease (PD), X-linked Dystonia Parkinsonism (XDP), and Essential Tremor (ET). HIFU thalamotomy is a noninvasive therapy for neurological conditions with debilitating tremors despite medication. To improve treatment accuracy and patient safety, neurosurgeons, neurologists, and anesthesiologists must work together perioperatively.

A total of 30 patients detailing their demographics, symptoms, and perioperative anesthetic management in a tertiary government hospital in Metro Manila was reviewed from October 2021 to March 2024. Most of the patients were diagnosed as PD tremor dominant, followed by XDP and ET. Majority of the cases were done under minimal sedation with local infiltration on the pin site while the rest were done under monitored anesthesia care combined with local anesthesia. Specific anesthetic agents were given to provide comfort and pain relief and reduce the risk of side effects.

During sonication, an essential element of the procedure, patients were closely monitored for the anticipated effects, such as paresthesia, headache, nausea, and vomiting, and were managed accordingly. Postoperatively, these patients were reported to have decreased tremors, stable vital signs, and adequate pain control. Collaboration among healthcare providers is one of the important elements for a successful outcome. This study highlights the importance of personalized anesthetic management in enhancing patient outcomes and the need for future studies about developing anesthesia protocols and strategies.

Human ; Essential Tremor