Lidocaine 4% / Tetracaine 0.5% / Adrenaline (base) 0.1% gel

(1) Background: Systemic mastocytosis is a rare, non-curable disease with potential life-threatening complications in patients receiving cardiac surgery. (2) Methods: This systematic review of the literature was prompted by the case of a life-threatening anaphylactic reaction during cardiac surgery related to systemic mastocytosis. The search of all types of studies, using several databases (Pubmed, Scopus and Web of Science), was conducted through September 2022 to identify the relevant studies. (3) Results: Twelve studies were included describing cases of patients undergoing cardiac surgery who were diagnosed with systemic mastocytosis. An adverse effect, namely anaphylaxis, has happened in three cases. Different strategies of premedication, intraoperative and postoperative management were used. In our case, the patient was admitted for elective biological aortic valve replacement due to severe aortic stenosis. Intraoperatively, the patient developed an anaphylactic shock during the administration of protamine after separation from the cardiopulmonary bypass. This anaphylaxis reaction was a complication of the pre-existing systemic mastocytosis and could be successfully managed by the administration of epinephrine, antihistamines and corticosteroids. (4) Conclusions: This systematic literature search and case report highlight the importance of careful preoperative planning, as well as coordination between cardiac surgeons, anesthesiologists and hemato-oncological specialists, in patients with rare but complication-prone diseases such as systemic mastocytosis.

Abstract licence: CC BY

PurposeThe aim was to investigate the time for intubation, adverse events and the comfort score of ultrasound-guided internal branch of superior laryngeal nerve block in patients with severe chronic obstructive pulmonary disorder (COPD) undergoing awake fibreoptic nasotracheal intubation.MethodsSixty patients with COPD who needed awake fibreoptic nasotracheal intubation were randomly and evenly divided into the ultrasound-guided internal branch of the superior laryngeal nerve block group (group S) and the control group (group C). All patients received procedural sedation with dexmedetomidine and adequate topical anaesthesia of the upper respiratory tract. Then, bilateral block was performed (with 2 mL of 2% lidocaine or the same volume of saline) followed by fibreoptic nasotracheal intubation. The primary outcomes were time for intubation, adverse reactions and comfort score. The secondary outcomes were haemodynamic changes and serum norepinephrine (NE) and adrenaline (AD) concentrations immediately before intubation (T0); immediately after intubation to the laryngopharynx (T1); and immediately (T2), 5 min (T3) and 10 min (T4) after intubation between the groups.ResultsCompared with group C, the time for intubation, the incidence of adverse reactions and the comfort score in group S were significantly lower (PPP>0.05). MAP, HR, NE and AD at T1-T4 were significantly lower in group S than in group C (PConclusionUltrasound-guided internal branch of the superior laryngeal nerve block can effectively shorten the time for intubation, reduce the incidence of adverse reactions, improve comfort score, maintain considerable haemodynamic stability and inhibit stress response in patients with severe COPD undergoing awake fibreoptic nasotracheal intubation.

Abstract licence: CC BY-NC

ObjectiveTo evaluate the safety and efficacy of dexmedetomidine amnestic analgesia slow induction for blind nasotracheal intubation (BNTI) in oral and maxillofacial surgery.MethodsSixty patients undergoing oral and maxillofacial surgery were randomly divided into the dexmedetomidine (DEX) group (1.0 μg/kg, 15 min of infusion + pethidine 1.0 mg/kg) and the midazolam (MID) group (0.02 mg/kg + pethidine 1.0 mg/kg). The intubation time was recorded, and heart rate (HR), mean arterial pressure (MAP), bispectral index (BIS) and pulse oximeter oxygen saturation (SpO2) were monitored at T0 (before induction), T1 (before intubation) and T2 (after intubation). Cortisol (Cor), norepinephrine (NE), epinephrine (E) and beta-endorphin (β-EP) levels were detected at T0, T3 (3 min after intubation) and T4 (15 min after intubation). The intraoperative fentanyl dosage, end-tidal carbon dioxide partial pressure (PETCO2) were recorded, and postoperative numerical rating scale (NRS) score, satisfaction and adverse reaction incidence were evaluated.ResultsCompared with the MID group, the intubation time in the DEX group was shorter and the PETCO₂ was lower (p p p p p p > 0.05).ConclusionDexmedetomidine used for blind nasotracheal intubation for oral and maxillofacial surgery can provide comprehensive anesthesia effects, significantly reduce the stress response of tracheal intubation and the dosage of intraoperative opioids, while maintaining good hemodynamic stability.

Abstract licence: CC BY

Pain is a common adverse effect of dermatological laser procedures. Currently, no standard topical anaesthetic cream exists for deeper dermal laser procedures.

Abstract licence: CC BY-NC-ND 4.0