Nguyen Dang Thu

Objective: Optimal positive end-expiratory pressure (PEEP) selection in acute respiratory distress syndrome (ARDS) is challenging because of marked regional lung heterogeneity. Electrical impedance tomography (EIT) provides bedside assessment of regional ventilation and may support individualized ventilation by informing PEEP titration, but evidence in trauma- and postoperative-associated ARDS remains limited. Methods: In this single-center randomized controlled trial, 86 adults with moderate-to-severe trauma- or postoperative-associated ARDS were randomized to an EIT-guided individualized ventilation strategy (n = 43) or a lower-PEEP/FiO ₂ strategy (n = 43). Four patients were transferred early before analyzable follow-up data were collected; therefore, the modified intention-to-treat population included 42 patients in the EIT group and 40 in the control group. In the EIT group, the multicomponent strategy included EIT monitoring, recruitment maneuvers, decremental PEEP titration, repeated reassessment, and individualized PEEP selection based on the intersection of regional collapse and overdistension curves. The co-primary physiologic outcomes were PaO₂/FiO₂ and static respiratory system compliance (Cstat), assessed longitudinally over 3 days. Secondary outcomes included mechanical power (MP), Sequential Organ Failure Assessment (SOFA) scores, ventilator-free days, ICU length of stay, barotrauma, and 28-day mortality. Prespecified exploratory analyses evaluated physiologic responses according to pulmonary contusion status. This study was powered for physiologic endpoints rather than clinical outcomes. Results: PaO₂/FiO₂ improved in both groups, with greater increases in the EIT group during Days 1–3 (Sidak-adjusted p < 0.05). Overall Cstat trajectories were similar between groups. The EIT-guided individualized ventilation strategy was associated with improved oxygenation without increases in plateau pressure or driving pressure. No differential temporal pattern in MP normalized to predicted body weight (MP/PBW) was observed, although overall values were modestly higher in the EIT group. Secondary clinical outcomes were broadly similar between groups. Exploratory analyses suggested greater SOFA score reduction and shorter ICU length of stay in the EIT group. Duration of mechanical ventilation, ventilator-free days, and 28-day mortality were similar between groups. Exploratory subgroup analyses suggested selected later improvements in Cstat among patients without pulmonary contusion, whereas MP/PBW was modestly higher in the EIT group across subgroups. Conclusions: In trauma- and postoperative-associated ARDS, an EIT-guided individualized ventilation strategy was associated with improved oxygenation compared with a lower-PEEP/FiO₂ strategy, while maintaining plateau and driving pressures within lung-protective ranges. These findings suggest the physiological feasibility of this strategy, but do not establish the independent effect of EIT monitoring or the underlying mechanistic pathway. Larger multicenter studies are needed to determine mechanisms and effects on patient-centered outcomes.

Patients undergoing non-elective surgery frequently require rapid sequence induction (RSI) because of concerns related to recent oral intake, impaired gast

Theo dõi độ sâu gây mê bằng điện não đồ (Electroencephalography - EEG) ngày càng trở nên phổ biến do phản ánh trung thực tình trạng sinh lý não trong quá trình gây mê. Thông tin hiển thị thường bao gồm chỉ số độ mê số hóa, điện não quang phổ hóa và điện não nguyên bản. Chỉ số độ mê số hóa giúp đơn giản, nhanh chóng trong xác định độ mê. Với cùng một giá trị hiển thị, độ mê thường được hiểu là như nhau mặc dù sử dụng thuốc mê khác nhau. Trên thực tế, mỗi thuốc mê có cơ chế và đích tác động khác nhau, tạo ra những kiểu sóng EEG đặc trưng và trạng thái sinh lý thần kinh khác nhau. Bài viết này nhằm tổng hợp các hiểu biết hiện tại về cơ chế tác dụng, đặc điểm EEG nguyên bản và quang phổ đặc trưng của một số thuốc mê thường dùng và mối liên quan đến những biểu hiện trên lâm sàng. Tài liệu phù hợp từ cơ sở dữ liệu PubMed, ScienceDirect và Google Scholar thông qua các từ khóa liên quan đến dược lý học thuốc mê và sự thay đổi EEG được tổng hợp và phân tích.

Administering anesthesia to pediatric patients with maxillofacial post-burn contractures poses significant challenges, particularly due to anticipated difficulties in airway management. We report two cases involving children with severe perioral adhesive scar contractures that resulted in markedly restricted mouth opening. These cases illustrate the complexity of anesthetic planning in such scenarios and emphasize the need for individualized strategies to ensure safety and effectiveness. In both cases, flexible bronchoscopy-guided intubation was not feasible due to anatomical limitations. Instead, a two-stage anesthetic approach was employed: initial intravenous anesthesia combined with local infiltration for scar release, followed by the placement of a supraglottic airway (ProSeal™ laryngeal mask airway) to establish adequate ventilation. Both patients were managed successfully, with stable intraoperative hemodynamics and uneventful postoperative recovery. Conclusion: Comprehensive preoperative airway evaluation is critical in pediatric patients with facial and cervical burn contractures. A staged anesthetic technique involving scar release under intravenous and local anesthesia can facilitate effective airway management and improve perioperative outcomes. Abbreviations: LMA: laryngeal mask airway; ETI: endotracheal intubation; NIBP: non-invasive blood pressure; EtCO2: end-tidal carbon dioxide Keywords: Airway; Airway Management; Difficult Endotracheal Intubation; Intravenous Anesthesia; Local Anesthesia; Post-Burn Scar Contracture; Surgical Release Citation: Vo HV, Nguyen QV, Nguyen TD, Nam NH. Airway management in pediatric patients with severe post-burn oral contractures: A report of two cases. Anaesth. pain intensive care 2025;29(4):425-229. DOI: 10.35975/apic.v29i4.2832 Received: March 25, 2025; Revised: May 6, May 12, 2024; Accepted: May 20, 2025

Background: Myasthenia gravis (MG) patients undergoing surgery may opt for general anesthesia without neuromuscular blocking agents (NMBAs). The univent tube, featuring a single lumen with bronchial blockers, is known for its flexibility and preference in challenging intubations, reducing airway damage during one-lung ventilation. This study assesses the safety and feasibility of utilizing the univent tube for thoracoscopic thymectomy in MG patients under general anesthesia without NMBAs, complemented by airway topical anesthesia. Methods: In this single-center, prospective observational study, 83 consecutive MG patients underwent thoracoscopic thymectomy with univent tube intubation. General anesthesia without NMBAs and airway topical anesthesia were administered. Emphasis was placed on intubation conditions, surgical aspects, intraoperative respiratory, and airway complications. Results: Clinically acceptable intubation conditions were achieved in 99% of patients, with 80% rated as ‘excellent’ and 19% as ‘good.’ No cases experienced intubation failure, and 2% exhibited reactions to tracheal tube insertion. Higher MG stages correlated with more favorable intubation conditions, particularly during laryngoscopy. Surgical conditions were excellent in 89%, and blocking the right lung increased total lung collapse, enhancing surgical conditions. Intraoperative ventilation was sufficient for all cases. Incidences of bronchial and vocal cord injuries were 6% and 10%, respectively, with no hematoma cases. Postoperative sore throat (12%) and hoarseness (6%) resolved within three days. Conclusions: Despite the potential benefits of NMBAs, the univent tube proved safe and effective for thoracoscopic thymectomy in MG patients without NMBAs, with higher MG stages associated with improved intubation conditions and enhanced surgical conditions with right-side bronchial blockage.

Introduction: Malignant hyperthermia (MH) is a fatal hypermetabolic reaction of skeletal muscle, triggered by exposure to volatile anesthetic agents or depolarizing muscle relaxants. It typically exhibits hypercarbia, muscle rigidity, tachycardia, and hyperthermia. Diagnosis is often confirmed through a muscle biopsy for the in vitro contracture test or by identifying pathogenic genetic variants. Case Presentation: We report 2 cases of suspected MH. The first case involved a 4-year-old female (20 kg) undergoing adenotonsillectomy, and the second involved a 13-year-old female (56 kg) who underwent pedicle screw fixation surgery. Both patients had unremarkable medical histories. During maintenance of general anesthesia with sevoflurane, they developed clinical signs highly suggestive of MH—10 minutes after exposure in the first case and 120 minutes after exposure in the second case. Both cases were managed with dantrolene and supportive care. In the first case, dantrolene was administered 4 hours after the initial signs, by which time significant rhabdomyolysis had already developed. In the second case, early administration within 10 minutes was associated with a much milder degree of rhabdomyolysis. Conclusion: Early recognition of symptoms and accurate differentiation of MH from similar conditions are essential for favorable outcomes. Prompt administration of dantrolene at the first sign of an MH reaction is critical for effective management.

Đánh giá chính xác độ sâu trong gây mê (độ mê) là cơ sở để duy trì mê ổn định, giúp tránh các nguy cơ do gây mê quá nông hoặc quá sâu, góp phần rút ngắn thời gian hồi tỉnh và nâng cao chất lượng điều trị. Các dấu hiệu lâm sàng đánh giá độ mê thường bị chồng lấn bởi kích thích đau nên chúng không đặc hiệu và khó lượng giá. Ngày nay, nhiều máy theo dõi điện não được phát triển và ứng dụng vào đánh giá độ mê với nhiều trường thông tin hiển thị và giá trị lâm sàng khác nhau. Hiểu được nguyên lý hình thành và ý nghĩa của các thông số giúp đánh giá độ mê được chính xác và toàn diện. Bài tổng quan nhằm khái quát về ứng dụng theo dõi hoạt động điện não trong đánh giá độ sâu gây mê và một số lưu ý trong thực hành lâm sàng.