WorldWideScience

Sample records for anesthesia closed-circuit

  1. Respiratory diagnostic possibilities during closed circuit anesthesia.

    Science.gov (United States)

    Verkaaik, A P; Erdmann, W

    1990-01-01

    An automatic feed back controlled totally closed circuit system (Physioflex) has been developed for quantitative practice of inhalation anesthesia and ventilation. In the circuit system the gas is moved unidirectionally around by a blower at 70 l/min. In the system four membrane chambers are integrated for ventilation. Besides end-expiratory feed back control of inhalation anesthetics, and inspiratory closed loop control of oxygen, the system offers on-line registration of flow, volume and respiratory pressures as well as a capnogram and oxygen consumption. Alveolar ventilation and static compliance can easily be derived. On-line registration of oxygen consumption has proven to be of value for determination of any impairment of tissue oxygen supply when the oxygen delivery has dropped to critical values. Obstruction of the upper or lower airways are immediately detected and differentiated. Disregulations of metabolism, e.g. in malignant hyperthermia, are seen in a pre-crisis phase (increase of oxygen consumption and of CO2 production), and therapy can be started extremely early and before a disastrous condition has developed. Registration of compliance is only one of the continuously available parameters that guarantee a better and adequate control of lung function (e.g. atalectasis is early detected). The newly developed sophisticated anesthesia device enlarges tremendously the monitoring and respiratory diagnostic possibilities of artificial ventilation, gives new insights in the (patho)physiology and detects disturbances of respiratory parameters and metabolism in an early stage. PMID:2260424

  2. [PhysioFlex: a target-controlled self-regulating closed-circuit inhalation anesthesia regulator].

    Science.gov (United States)

    Nathan, N; Sperandio, M; Erdmann, W; Westerkamp, B; Van Dijk, G; Scherpereel, P; Feiss, P

    1997-01-01

    Physi Flex is the first commercially available apparatus capable for quantitative, or self-regulating target controlled inhalational anaesthesia, with a totally closed circuit, in adults and children. The fresh gas supply to the circuit is intermittent, automatically regulated by continuous monitoring of the volume and composition of the gas mixture in the breathing circuit. The circle system includes, instead of the two conventional one way valves, a blower creating a continuous unidirectional flow at 70 L.min-1. In addition to the CO2-absorber it contains an absorber with carbon, absorbing the anaesthetic vapour when switched into the circuit. The ventilator consists of four ventilating chambers, each one with a membrane separating the patient and the motor compartments. The displacement of the membranes generates and measures the tidal volume. Automatic ventilation is achieved by electric valves and motor gas, and manual ventilation using a bag. Spontaneous ventilation is also possible. The machine is operated via a computer with selects the number of ventilating chambers (one, two or four), and the tidal volume between 50 and 2,000 mL, depending on age, gender and weight of the patient. The computer maintains the gas volume and the gas and vapour concentrations at their preset values. The O2-flow and consumption, the N2O flow and uptake, FICO2 and FETCO2, FI and FET of the volatile anaesthetic, all other important data are displayed in a numerical and graphical form on a color screen and registered for a delayed analysis. The end tidal concentration of the volatile anaesthetic drives a stepmotor with a syringe containing the selected volatile anaesthetic agent with is directly injected into the breathing circuit where it is vaporized. Therefore the concentration of the anaesthetic vapour can be instantaneously increased with this injector at induction and lowered at end of anaesthesia with the carbon absorber, and the fresh gas consumption is significantly

  3. Closed-form solutions for the optimum equivalence of first-order compartmental models and their implications for classical models of closed-circuit anesthesia

    International Nuclear Information System (INIS)

    Given a function that describes the uptake of a substance into the body with time, an analytical technique is described which transforms that function into a model of parallel first-order compartments that converges to the same uptake profile as the number of compartments is increased. The fitting of the compartmental model to the given uptake function is optimized to minimize the squared error. A necessary condition of the analytical method is that the uptake function be capable of being successively integrated at least as many times as the number of desired compartments. The uptake function should also be monotonically decreasing as all parallel first-order compartment models predict monotonically decreasing uptake. We applied this technique and ascertained the compartmental structure of the Severinghaus relationship, a longstanding observation in the field of clinical anesthesia that the uptake of nitrous oxide follows an inverse-square-root of time profile. The Severinghaus relationship is numerically poorly behaved at a time of zero elapsed minutes, predicting an instantaneously infinite uptake. Nevertheless, modeling of the first minute of anesthesia is necessary for characterizing the initial induction of anesthesia and methods of maintaining closed-circuit anesthesia such as the unit dose method. Using solely analytical methods, solutions for the compartmental properties of a mammillary model that matches the Severinghaus relationship for any expressed time interval are produced. These properties are compared to currently accepted values for the uptake of nitrous oxide. When matched to the Severinghaus relationship in the range of 0–100 min with a three-compartment model, we identified time constants of 0.28, 4.69 and 33.49 min with associated apparent volumes of 1.44, 2.14 and 7.97 l, respectively. The time constants in particular contrast to our earlier findings for the range of 1–100 min (1.46, 7.41 and 42.0 min). Our earlier findings were well

  4. Closed Circuit Videoinstallationen

    DEFF Research Database (Denmark)

    Kacunko, Slavko

    and 650 artists. This and the notes on further reading and viewing will enable deeper explorations of the material in a way not unlike the open “hyper-text”- structure. Video technique makes it possible to simultaneously record and reproduce images, sound and sequences of motion; that potential can...... and at the same time general investigations. The research project, ‘Closed-Circuit-Video Installations. A Study on the History and Theory of Media Art’, is being supported by the Fritz-Thyssen Foundation, Cologne....

  5. Anesthesia

    Science.gov (United States)

    ... arm or leg. A common type is epidural anesthesia, which is often used during childbirth. General - makes ... afterwards. Sedation can be used with or without anesthesia. The type of anesthesia or sedation you get ...

  6. Introducing closed circuit television for safeguards surveillance

    International Nuclear Information System (INIS)

    In the second half of the 1980s 8 mm film and camera production, used by the IAEA for safeguards surveillance purposes, was discontinued worldwide as so called camcorders began to dominate the market. It became clear that it would be necessary to replace all of the installed twin camera units by closed circuit television systems, which offer the following advantages over 8 mm film cameras: higher picture capacity and quality; higher light sensitivity; the possibility of date and time annotation; and a lower sensitivity to nuclear radiation. The present article describes the planning of this transition by a special working group, the development of alternative equipment for the film camera systems through the safeguards support programmes of Canada, Germany, Japan and the USA; and the progress that has been achieved so far. 4 refs, 2 figs, 1 tab

  7. 49 CFR 236.786 - Principle, closed circuit.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Principle, closed circuit. 236.786 Section 236.786 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Principle, closed circuit. The principle of circuit design where a normally energized electric circuit...

  8. Closed-Circuit Television Trends and Tactics in America's Schools.

    Science.gov (United States)

    Sorrentino, Dominic

    2002-01-01

    Describes the how school districts use closed circuit television (CCTV) surveillance to improve school safety. Discusses technological improvements in CCTV, including digital imagery. Provides examples of CCTV use in several school districts. (PKP)

  9. Dieter Kiessling. Closed-Circuit Video 1982 – 2000

    DEFF Research Database (Denmark)

    Kacunko, Slavko

    2001-01-01

    features there can be generalised with certainty and observed similarly in non-artistic feedback phenomena. The twenty pieces by this German artist as completed over the past nineteen years and described in the book, testify to his consistent and successful further development of his investigations begun......Whitehead’s critique of instantaneity (closed circuit technique still being generally known under the term of ‘Instant Feedback’ at the time) and his inferences of process philosophy, can, at least as an implication, be sensed in Dieter Kiessling’s closed-circuit video installations. Some of the...... the consequences of these adjacent theoretical approaches has to be a critical evaluation of current theoretical trends that perceive in computerised ‘real time’-processing programmes such as ‘morphing’, a substantially new and revolutionary development, and which would make a sharp distinction...

  10. Closed-circuit TV: an effective patient education tool.

    Science.gov (United States)

    Chan, V

    1992-01-01

    Patient education is well accepted to be an integral component of professional nursing practice. Although most nurses value patient teaching, the reality of the nursing shortage demands that innovative strategies be utilized to plan, implement and evaluate in-hospital patient education programs. Advances in computer technology have made closed-circuit television (CCTV) an attractive option for hospitals to fulfil their patient education mandate. As a delivery system, CCTV can be of considerable value. But as is true of other instructional media used to supplement educational efforts, CCTV also provides many traps that can limit its effectiveness. The biggest danger is the misuse of the tool by attempting to replace rather than supplement human interaction during the education process. This paper provides practical suggestions for the creative use of CCTV as a teaching tool to enhance patient education efforts. Pitfalls inherent in planning and implementing a CCTV system will be discussed. PMID:1463759

  11. 77 FR 28601 - Announcement of an Opportunity for Manufacturers and Designers of Closed Circuit Escape...

    Science.gov (United States)

    2012-05-15

    ...://www.gpo.gov/fdsys/pkg/FR-2012-03-08/pdf/2012-4691.pdf ), Approval Tests and Standards for Closed-Circuit Escape Respirators (CCERs) on March 8th 2012. This final rule revised and updated the requirements... Manufacturers and Designers of Closed Circuit Escape Respirators To Participate in Performance Testing Within...

  12. 49 CFR 236.5 - Design of control circuits on closed circuit principle.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Design of control circuits on closed circuit..., AND APPLIANCES Rules and Instructions: All Systems General § 236.5 Design of control circuits on closed circuit principle. All control circuits the functioning of which affects safety of train...

  13. 21 CFR 886.5820 - Closed-circuit television reading system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Closed-circuit television reading system. 886.5820... reading system. (a) Identification. A closed-circuit television reading system is a device that consists... vision to magnify reading material. (b) Classification. Class I (general controls). The device is...

  14. The closed circuit and the low flow systems

    Directory of Open Access Journals (Sweden)

    S Parthasarathy

    2013-01-01

    Full Text Available A breathing system is defined as an assembly of components, which delivers gases from the anesthesia machine to the patients′ airways. When the components are arranged as a circle, it is termed a circle system. The flow of exhaled gases is unidirectional in the system. The system contains a component (absorber, which absorbs exhaled carbon dioxide and it is not necessary to give high fresh gas flows as in Mapleson systems. When the adjustable pressure limiting (APL valve is closed and all the exhaled gases without carbon dioxide are returned to the patient, the system becomes a totally closed one. Such a circle system can be used with flows as low as 250 to 500 mL and clinically can be termed as low-flow systems. The components of the circle system can be arranged in different ways with adherence to basic rules: (1 Unidirectional valve must be present between the reservoir bag and the patient on both inspiratory and expiratory sides; (2 fresh gas must not enter the system between the expiratory unidirectional valve and the patient; and (3 the APL valve must not be placed between the patient and the inspiratory unidirectional valve. The functional analysis is explained in detail. During the function, the arrangement of components is significant only at higher fresh gas flows. With the introduction of low resistance valves, improved soda lime canisters and low dead space connectors, the use of less complicated pediatric circle systems is gaining popularity to anesthetize children. There are bidirectional flow systems with carbon dioxide absorption. The Waters to and fro system, a classic example of bidirectional flow systems with a canister to absorb carbon dioxide, is valveless and portable. It was widely used in the past and now is only of historical importance.

  15. Dynamic modeling and analysis of the closed-circuit grinding-classification process

    Institute of Scientific and Technical Information of China (English)

    Yunfei Chu; Wenli Xu; Weihan Wan

    2005-01-01

    Mathematical models of the grinding process are the basis of analysis, simulation and control. Most existent models including theoretical models and identification models are, however, inconvenient for direct analysis. In addition, many models pay much attention to the local details in the closed-circuit grinding process while overlooking the systematic behavior of the process as a whole. From the systematic perspective, the dynamic behavior of the whole closed-circuit grinding-classification process is considered and a first-order transfer function model describing the dynamic relation between the raw material and the product is established.The model proves that the time constant of the closed-circuit process is lager than that of the open-circuit process and reveals how physical parameters affect the process dynamic behavior. These are very helpful to understand, design and control the closed-circuit grinding-classification process.

  16. Anesthesia Awareness

    Science.gov (United States)

    ... and Anesthesia Smoking and Anesthesia Outpatient Surgery Anesthesia Awareness Very rarely – in only one or two out ... become aware or conscious. The condition – called anesthesia awareness – means the patient can recall the surroundings or ...

  17. Modeling and control of a LN2-GN2 operated closed circuit cryogenic wind tunnel

    Science.gov (United States)

    Balakrishna, S.; Thibodeaux, J. J.

    1979-01-01

    An explicit but simple lumped parameter nonlinear multivariable model of a LN2-GN2-operated closed circuit cryogenic wind tunnel has been developed and its basic features have been experimentally validated. The model describes the mass-energy interaction involved in the cryogenic tunnel process and includes the real gas properties of nitrogen gas.

  18. Computer presentation of the closed circuits in mineral processing by software computer packets

    OpenAIRE

    Krstev, Aleksandar; Krstev, Boris; Golomeov, Blagoj

    2009-01-01

    In this paper will be shown computer application of softwares Minteh-1, Minteh-2 and Minteh-3 in Visual Basic, Visual Studio for presentation of two-products for some closed circuits od grinding-clasifying processes. These methods make possibilities for appropriate, fasr and sure presentation of some complex circuits in the mineral processing technologies.

  19. Identification of cognitive factors related to remote work performance using closed circuit TV displays

    Science.gov (United States)

    Clarke, M. M.; Garin, J.

    1981-01-01

    Operator perceptual cognitive styles as predictors of remote task performance were identified. Remote tasks which require the use of servo controlled master/slave manipulators and closed circuit television for teleoperator repair and maintenance of nuclear fuel recycling systems are examined. A useful procedure for identifying such perceptual styles is described.

  20. The possibilities of using closed circuit gas system for dust removal in unit 'Shelter'

    International Nuclear Information System (INIS)

    The closed circuit gas system for dust removal in unit 'Shelter' is proposed. The basic circuit of such system is simple in design, installation and operation, and its cost is rather low. The dust contents in the effluent after cleaning is reduced according to calculation (with number of the closed loops n = 10), more than three orders of magnitude

  1. The Psychosocial Impact of Closed-Circuit Televisions on Persons with Age-Related Macular Degeneration

    Science.gov (United States)

    Huber, Jessica G.; Jutai, Jeffrey W.; Strong, J. Graham; Plotkin, Ann D.

    2008-01-01

    Closed-circuit televisions (CCTVs) are used by many elderly people who have age-related macular degeneration (AMD). The functional vision of 68 participants, which was measured immediately after they adopted CCTVs, suggested successful outcomes, but the psychosocial impact of the use of CCTVs did not peak until a month later. The findings help…

  2. Airborne particle monitoring with urban closed-circuit television camera networks and a chromatic technique

    International Nuclear Information System (INIS)

    An economic approach for the preliminary assessment of 2–10 µm sized (PM10) airborne particle levels in urban areas is described. It uses existing urban closed-circuit television (CCTV) surveillance camera networks in combination with particle accumulating units and chromatic quantification of polychromatic light scattered by the captured particles. Methods for accommodating extraneous light effects are discussed and test results obtained from real urban sites are presented to illustrate the potential of the approach

  3. A novel ambulatory closed circuit breathing system for use during exercise.

    LENUS (Irish Health Repository)

    McMorrow, R C N

    2011-05-01

    We describe a unique ambulatory closed circuit for delivering high fractions of inspired oxygen to an exercising user who does not require isolation from their environment. We describe the major components and their function and suggest potential applications for such a circuit. This circuit may benefit patients who are chronically dependant on oxygen, are unable to exercise due to hypoxia, or require oxygen supplementation at high altitude.

  4. Closed circuit rebreathing to achieve inert gas wash-in for multiple breath wash-out

    OpenAIRE

    Alex R. Horsley; Katherine O'Neill; Downey, Damian G.; J Stuart Elborn; Nicholas J. Bell; Jaclyn Smith; John Owers-Bradley

    2016-01-01

    Multiple breath wash-out (MBW) testing requires prior wash-in of inert tracer gas. Wash-in efficiency can be enhanced by a rebreathing tracer in a closed circuit. Previous attempts to deploy this did not account for the impact of CO2 accumulation on patients and were unsuccessful. We hypothesised that an effective rebreathe wash-in could be delivered and it would not alter wash-out parameters. Computer modelling was used to assess the impact of the rebreathe method on wash-in efficiency. Clin...

  5. General anesthesia

    Science.gov (United States)

    General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel ... doctor called an anesthesiologist will give you the anesthesia. Sometimes, a certified and registered nurse anesthetist will ...

  6. Acutely induced anxiety increases negative interpretations of events in a closed-circuit television monitoring task.

    Science.gov (United States)

    Cooper, Robbie; Howard, Christina J; Attwood, Angela S; Stirland, Rachel; Rostant, Viviane; Renton, Lynne; Goodwin, Christine; Munafò, Marcus R

    2013-01-01

    In two experiments we measured the effects of 7.5% CO₂ inhalation on the interpretation of video footage recorded on closed circuit television (CCTV). As predicted, inhalation of 7.5% CO₂ was associated with increases in physiological and subjective correlates of anxiety compared with inhalation of medical air (placebo). Importantly, when in the 7.5% CO₂ condition, participants reported the increased presence of suspicious activity compared with placebo (Experiment 1), a finding that was replicated and extended (Experiment 2) with no concomitant increase in the reporting of the presence of positive activity. These findings support previous work on interpretative bias in anxiety but are novel in terms of how the anxiety was elicited, the nature of the interpretative bias, and the ecological validity of the task. PMID:22780582

  7. Pre-alarm closed circuit television verification to reduce false alarm impact

    International Nuclear Information System (INIS)

    Closed circuit television (CCTV) plays an important role in modern security systems for protection of nuclear material. The functions of video are for detection and to assist in classification or assessment of alarms from other sensors. A nuclear facility with an extensive security system can experience a very high alarm rate, including false, nuisance and alarms occurring as part of routine operations. Video systems which include the Pre-Alarm Image Recall feature continuously capture and store a number of images from each camera. The images leading up to, at the instant of, and immediately after an alarm, can be displayed as a very valuable aid in assessment. The technology and operation of this feature is described, together with actual operating experience and a summary of the benefits which have been obtained from its use. (author)

  8. Identification of microbial communities in open and closed circuit bioelectrochemical MBRs by high-throughput 454 pyrosequencing.

    Directory of Open Access Journals (Sweden)

    Jian Huang

    Full Text Available Two bioelectrochemical membrane bioreactors (MBRs developed by integrating microbial fuel cell and MBR technology were operated under closed-circuit and open-circuit modes, and high-throughput 454 pyrosequencing was used to investigate the effects of the power generation on the microbial community of bio-anode and bio-cathode. Microbes on the anode under open-circuit operation (AO were enriched and highly diverse when compared to those on the anode under closed-circuit operation (AC. However, among the cathodes the closed-circuit mode (CC had richer and more diverse microbial community compared to the cathode under open-circuit mode (CO. On the anodes AO and AC, Proteobacteria and Bacteroidetes were the dominant phyla, while Firmicutes was enriched only on AC. Deltaproteobacteria affiliated to Proteobacteria were also more abundant on AC than AO. Furthermore, the relative abundance of Desulfuromonas, which are well-known electrogenic bacteria, were much higher on AC (10.2% when compared to AO (0.11%, indicating that closed-circuit operation was more conducive for the growth of electrogenic bacteria on the anodes. On the cathodes, Protebacteria was robust on CC while Bacteroidetes was more abundant on CO. Rhodobacter and Hydrogenophaga were also enriched on CC than CO, suggesting that these genera play a role in electron transfer from the cathode surface to the terminal electron acceptors in the bioelectrochemical MBR under closed-circuit operation.

  9. Review of Closed Circuit Television (CCTV Techniques for Vehicles Traffic Management

    Directory of Open Access Journals (Sweden)

    Heba A. Kurd

    2014-04-01

    Full Text Available Due to the population increase all over the world current road infrastructu res are unable to keep up with the escalating transportation demands. This situation where travel demands exceeds the capacity of the transportation network is known as traffic congestion. However, it is impractical to build more roads and infrastructure to accommodate these demands. Governments are increasingly recognizing the importance of traffic control tools, such as Closed Circuit Television (CCTV system s as a feasible solution to mitigate the traffic congestion problem. CCTV systems are deployed across city centres , motorways, trunk roads, car parks etc. , to collect diverse data on large regions where manual observation can be difficult, problematic or unfeasible . By processing th is data, which contains video images of t raffic parameters, useful information can be extracted , including speed, traffic composition, vehicle shapes, vehicle types , vehicle identification numbers and occurrence s of traffic violations or road accidents . This paper reviews different approaches to utilize CCTV systems for traffic management of Vehicles . It highlights existing architectural, deployment models , and various approaches to analys e generated traffic data . The objective is to provide a clear background that can help in any related future research .

  10. Closed-circuit television and remote crane control for vitrification facilities

    International Nuclear Information System (INIS)

    The Defense Waste Processing Facility is currently under construction at the Savannah River Plant. Within the main process cell (MPC), a 117-ton capacity bridge crane is to be installed to facilitate remote handling and processing operations. E. I. du Pont de Nemours and Company defined and PRC designed and built an operational prototype closed-circuit television (CCTV) and remote control system. Phase I of the program developed the CCTV system to prove the feasibility of a remote viewing system. The phase II program added full crane functional remote control and installed it on an existing hot canyon crane. This prototype system established the criteria for the development of the MPC crane and future crane systems. Parameters were: (a) failsafe assurance, (b) high liability, (c) ease of maintenance for dressed-out personnel, (d) rapid malfunction diagnosis, (e) ergonomics, (f) known picture orientation, and (g) audio system to monitor operational sounds. The complete system has undergone a total demonstration of its operational capabilities using simulator circuits for crane functions and is now being integrated with the crane for a full operational demonstration. The system will then be mothballed pending installation by construction personnel ready for cold startup of the plant in 1988

  11. Spinal and epidural anesthesia

    Science.gov (United States)

    Intraspinal anesthesia; Subarachnoid anesthesia; Epidural; Peridural anesthesia ... Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). Patients usually recover their senses ...

  12. Microbial community differences between propionate-fed microbial fuel cell systems under open and closed circuit conditions.

    OpenAIRE

    Aguirre de Cárcer, Daniel; Ha, Phuc Yhi; Jang, Jae Kyung; Chang, In Seop

    2014-01-01

    We report the electrochemical characterization and microbial community analysis of closed circuit microbial fuel cells (CC-MFCs) and open circuit (OC) cells continuously fed with propionate as substrate. Differences in power output between MFCs correlated with their polarization behavior, which is related to the maturation of the anodophilic communities. The microbial communities residing in the biofilm growing on the electrode, biofouled cation-exchange membrane and anodic chamber l...

  13. Seniors and Anesthesia

    Science.gov (United States)

    ... Media Anesthesia 101 Patient Safety Stories Resources About Home » Patients » Preparing For Surgery » Seniors and Anesthesia Share this Page Preparing For Surgery Effects of Anesthesia Children and Anesthesia Pregnancy, Childbirth and Anesthesia Seniors and Anesthesia Surgery Risks Anesthesia ...

  14. Anesthesia Basics

    Science.gov (United States)

    ... giving you anesthesia. CRNAs may work under the supervision of a anesthesiologist or on their own — it ... lot over the years, thanks to advances in technology and the extensive training anesthesiologists receive. The more ...

  15. Postoperative effects of anesthesia and surgery on resting energy expenditure in horses as measured by indirect calorimetry

    OpenAIRE

    Cruz, Antonio M.; Coté, Nathalie; McDonell, Wayne N.; Geor, Raymond J.; Wilson, Brian A.; Monteith, Gabrielle; Li, Ronald

    2006-01-01

    In this study, we aimed to define the effects of anesthesia and surgery on the resting energy expenditure of horses in experimental conditions. Six horses were used in a longitudinal study with 2 study periods: before and after anesthesia and surgery. Every horse underwent a standard 90-min ventral midline exploratory laparotomy. Oxygen uptake ( ) and carbon dioxide output ( ) were measured, with the use of a closed-circuit spirometry system, on 5 consecutive days immediately before and...

  16. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ... 6620 | E-mail: info@sambahq.org Copyright | 2016 Society for Ambulatory Anesthesia Home | Search | Terms | Privacy Policy | ...

  17. Obesity and Anesthesia

    Science.gov (United States)

    ... Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Obesity and Anesthesia More than one-third of Americans ... Sleep Apnea, a chronic medical problem common with obesity, can present with serious breathing problems before, during, ...

  18. Anesthesia for fetoscopic intervention

    Directory of Open Access Journals (Sweden)

    Jamil S Anwari

    2014-01-01

    Full Text Available This is the first case report on anesthesia for fetoscopy performed in Saudi Arabia. Epidural anesthesia was given to the mother in her late second trimester for the fetoscopic intervention. The anesthesia related issues such as physiological and anatomical changes in pregnancy, tocolytic medications and their interactions with anesthesia, anesthetizing/sedating the primary patient are discussed.

  19. Hand Surgery: Anesthesia

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Hand Surgery Anesthesia Email to a friend * required fields From * To * ... in to name and customize your collection. DESCRIPTION Anesthesia is a way to control pain during a ...

  20. Topical anesthesia in phacoemulsification

    Directory of Open Access Journals (Sweden)

    Saad Waheeb

    2010-01-01

    Conclusion : Topical anesthesia is a satisfactory and safe alternative to retrobulbar and peribulbar anesthesia for clear corneal phacoemulsification and intraocular lens implantation in selected cataract patients in the hands of experienced cataract surgeon.

  1. Effects of Anesthesia

    Science.gov (United States)

    ... Regional Anesthesia The potential side effects of regional anesthesia (such as an epidural or spinal block, in which an anesthetic is injected in ... days after the procedure if some of the spinal fluid leaks out. Minor back ... was injected. Serious but rare complications include: Pneumothorax – ...

  2. Helicopter flight investigation to determine the effects of a closed-circuit TV on performance of a precision sling-load handling task

    Science.gov (United States)

    Dicarlo, D. J.; Kelley, H. L.; Spivey, D. L.

    1974-01-01

    Helicopter sling-load operations have been limited during hover and low-speed flight by the degree of precision achieved by the pilot/helicopter/sling-load combination. Previous attempts to improve precision have included stabilization of the load and helicopter and the addition of a pilot station directly facing the load. In these tests, use of a closed-circuit TV as a display that would permit sling-load delivery and placement by the forward-facing pilot was evaluated using a CH-54B helicopter. In all, three test cases were documented, which included the following: (1) forward-facing pilot using the TV display, (2) forward-facing pilot using verbal commands from a load-facing observer, and (3) aft-facing pilot using direct visual cues. The results indicate that a comparable level of performance was achieved for each test case; however, an increase in pilot workload was noted when the TV system was used.

  3. Orthopedic Anesthesia in Haiti

    OpenAIRE

    Osteen, Kristie D.

    2011-01-01

    Healthcare practitioners from around the world responded almost immediately in the aftermath of the 2010 earthquake in Haiti. This article reports on the efforts of an orthopedic trauma team in Haiti and its efforts in providing surgery without general anesthesia.

  4. The effect of different inflation volumes of laryngeal mask airway on efficacy of closed circuit controlled ventilation in pediatric cancer patients

    Institute of Scientific and Technical Information of China (English)

    Magda S. Azer; Ayman A. Ghoneim; Hossam Z. Ghobrial

    2013-01-01

    Objective:The laryngeal mask airway (LMA) is an established way for airway control during spontaneous ventila-tion. Its ability to deliver positive pressure ventilation without leakage especial y in low flow states is stil controversy. The aim of this study is to test the possibility of using LMA in pediatric closed circuit control ed ventilation, and to find out the optimum cuf volume to perform closed system ventilation. Methods:Twenty children scheduled for elective surgeries were enrol ed in a crossover study. Laryngeal mask airway was used. In stage I, the cuf was inflated with the maximum volume of air as rec-ommended by the manufacturers. Adjustment of volume of air inflated into the LMA cuf to the minimum volume to obtain the ef ective seal was done at stage II. The leak pressure, intracuf pressure and the leak volume were measured in both stages. Results:The cuf fil ing volume was significantly lower compared to the maximum cuf inflation volume in stage I. Leakage values showed significantly less values in stage II of the study with smal er cuf inflation volumes. The airway leakage pressure was significantly lower in stage II in comparison to stage I. Cuf inflation pressure in stage I showed marked elevation which dropped significantly after adjustment of cuf volume in stage II. Conclusion:Laryngeal mask airway is an ef ective tool to provide closed circuit control ed ventilation in pediatrics. Inflation of the cuf by the minimum volume of air needed to reach the just sealing pressure is suggested to minimize the leakage volume.

  5. NEURAXIAL ANESTHESIA and OBESITY

    OpenAIRE

    Şahin, Aynur; Doğru, Hatice Yılmaz

    2013-01-01

    Obesity is one of the serious condition that commonly effects health in modern age. It was reported that obesity was three-fold increased in the last three decades. According to the statement by World Health Organisation in 2005, 700 million people will be estimated obese in 2015. While neuraxial anesthesia is a commonly used technique in the worldwide, the process may have difficulties in obese patients. In this review, the pathophysiological changes and challenges in neuraxial anesthesia ...

  6. Anesthesia for radiologic procedures

    International Nuclear Information System (INIS)

    Anesthetic techniques for neurodiagnostic studies and radiation therapy have been recently reviewed, but anesthetic involvement in thoracic and abdominal radiology has received little attention. Patient reactions to radiologic contrast media may be of concern to the anesthesiologist, who is often responsible for injecting these agents during diagnostic procedures, and thus is included in this discussion. Finally, the difficulties of administering anesthesia for magnetic resonance imaging (MRI) scans are outlined, in an effort to help anesthesiologist to anticipate problems with this new technologic development. Although there are very few indications for the use of general anesthesia for diagnostic radiologic studies in adults, most procedures performed with children, the mentally retarded, or the combative adult require either heavy sedation or general anesthesia. In selecting an anesthetic technique for a specific procedure, both the patient's disease process and the requirements of the radiologist must be carefully balanced

  7. Regional Anesthesia in Trauma Medicine

    OpenAIRE

    Loreto Lollo; Wu, Janice J.; Andreas Grabinsky

    2011-01-01

    Regional anesthesia is an established method to provide analgesia for patients in the operating room and during the postoperative phase. While regional anesthesia offers unique advantages, as shown by the recent military experience, it is not commonly utilized in the prehospital or emergency department setting. Most often, regional anesthesia techniques for traumatized patients are first utilized in the operating room for procedural anesthesia or for postoperative pain control. While infiltra...

  8. Anesthesia for interventional radiology

    International Nuclear Information System (INIS)

    We recognized that the complexity and surgical nature of many interventional radiology procedures dictate essential radiologic involvement into traditional anesthesiologic areas. They reviewed our experience with a variety of interventional procedures to document complications and problems related to anesthetic use (or misuse) and compile recommendations for rational monitoring and control for these procedures. In particular, the authors have studied complications of drug therapies and the treatment of these complications; use of complex anesthesia procedures (e.g., epidural anesthesia, succinylcholine blockage); reasons for choice of drugs (e.g., fentanyl vs meperidine vs morphine); and medico-legal aspects of radiologist performing traditional anesthesiology-type procedures

  9. Remote crane control techniques and closed-circuit television for the U.S. Department of Energy, Defense Waste Processing Facility

    International Nuclear Information System (INIS)

    The Defense Waste Processing Facility (DWPF) located at the Savannah River Plant (SRP), South Carolina is a nuclear waste facility being built to vitrify and containerize high level radioactive waste products. DWPF has a unique requirement for an unmanned crane system to install and replace equipment in the high humidity, high radiation and harsh chemical environment of permanently inaccessible processing cells. A radio control system is provided to control a 117 ton capacity bridge crane that is equipped with various power tools for remote handling of crane replaceable and maintained equipment. High resolution black and white closed circuit television (CTV) assemblies mounted on the crane and on the walls of the various processing cells are provided for viewing the equipment during normal operations and maintenance. The main process cell (MPC) crane is designed as the vehicle to be the eyes, ears and hands for remote in-cell operations and maintenance. The crane runs on elevated rails above the process cells. A trailer-like-electrical equipment compartment (EEC) containing control and radio communications equipment for the crane; is dragged along on rails in a heavily shielded corridor by a drag bar mounted to the crane. A two way RF system is the communications link for all control and video signals between the crane and two stationary crane control consoles

  10. Effects of standard training in the use of closed-circuit televisions in visually impaired adults: design of a training protocol and a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van Rens Ger HMB

    2010-03-01

    Full Text Available Abstract Background Reading problems are frequently reported by visually impaired persons. A closed-circuit television (CCTV can be helpful to maintain reading ability, however, it is difficult to learn how to use this device. In the Netherlands, an evidence-based rehabilitation program in the use of CCTVs was lacking. Therefore, a standard training protocol needed to be developed and tested in a randomized controlled trial (RCT to provide an evidence-based training program in the use of this device. Methods/Design To develop a standard training program, information was collected by studying literature, observing training in the use of CCTVs, discussing the content of the training program with professionals and organizing focus and discussion groups. The effectiveness of the program was evaluated in an RCT, to obtain an evidence-based training program. Dutch patients (n = 122 were randomized into a treatment group: normal instructions from the supplier combined with training in the use of CCTVs, or into a control group: instructions from the supplier only. The effect of the training program was evaluated in terms of: change in reading ability (reading speed and reading comprehension, patients' skills to operate the CCTV, perceived (vision-related quality of life and tasks performed in daily living. Discussion The development of the CCTV training protocol and the design of the RCT in the present study may serve as an example to obtain an evidence-based training program. The training program was adjusted to the needs and learning abilities of individual patients, however, for scientific reasons it might have been preferable to standardize the protocol further, in order to gain more comparable results. Trial registration http://www.trialregister.nl, identifier: NTR1031

  11. Anesthesia and cor triatriatum

    OpenAIRE

    Federica Scavonetto; Tze Yeng Yeoh; Tasha L Welch; Weingarten, Toby N.; Juraj Sprung

    2014-01-01

    Aims and Objectives: Cor triatriatum sinistrum (CTS) and cor triatriatum dextrum (CTD) are rare congenital anomalies characterized by the presence of a perforated septum which divides the respective atrium into a proximal and distal chamber. This report reviews the perioperative course of patients with uncorrected cor triatriatum (CT) undergoing procedures requiring anesthesia. In addition, we performed a literature search that examines the experience of others regarding the peri-operative co...

  12. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  13. Safe Anesthesia For Every Tot

    DEFF Research Database (Denmark)

    Weiss, Markus; Vutskits, Laszlo; Hansen, Tom G;

    2015-01-01

    PURPOSE OF REVIEW: The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS: The Safe Anesthesia For Every Tot initiative (www.safetots.org) has been set up during the last year to focus on the...... improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the safetots.org initiative. SUMMARY: This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps in...

  14. Anesthesia - what to ask your doctor - adult

    Science.gov (United States)

    ... that I am having? General anesthesia Spinal or epidural anesthesia Conscious sedation When do I need to stop ... to my stomach? If I have spinal or epidural anesthesia, will I have a headache afterwards? What if ...

  15. Anesthesia - what to ask your doctor - child

    Science.gov (United States)

    ... my child is having? General anesthesia Spinal or epidural anesthesia Conscious sedation When does my child need to ... upset stomach? If my child had spinal or epidural anesthesia, will my child have a headache afterwards? What ...

  16. Anesthesia for bronchoscopy.

    Science.gov (United States)

    Abdelmalak, Basem B; Gildea, Thomas R; Doyle, D John

    2012-01-01

    Bronchoscopic procedures are at times intricate and the patients often very ill. These factors and an airway shared with the pulmonologist present a clear challenge to anesthesiologists. The key to success lies in the understanding of both the underlying pathology and procedure being performed combined with frequent two-way communication between the anesthesiologist and the pulmonologist. Above all, vigilance and preparedness are paramount. Topics discussed in this review include anesthesia for advanced diagnostic procedures as well as for interventional/ therapeutic procedures. The latter includes bronchoscopic tracheal balloon dilation, tracheobronchial stenting, endobronchial electrocautery, bronchoscopic cryotherapy and other techniques. Special situations, such as tracheoesophageal fistula and mediastinal masses, are also considered. PMID:22762465

  17. Anesthesia for thoracoscopic surgery

    Directory of Open Access Journals (Sweden)

    Conacher I

    2007-01-01

    Full Text Available Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

  18. Paediatric Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Rakhee Goyal

    2008-01-01

    Full Text Available Paediatric spinal anesthesia is not only a safe alternative to general anaesthesia but often the anaesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and feasibility is broken and is now found to be even more cost-effective. It is a much preferred technique especially for the common daycase surgeries generally performed in the paediatric age group. There is no require-ment of any additional expensive equipment either and this procedure can be easily performed in peripheral centers. However, greater acceptance and experience is yet desired for this technique to become popular.

  19. Anesthesia and cor triatriatum

    Directory of Open Access Journals (Sweden)

    Federica Scavonetto

    2014-01-01

    Full Text Available Aims and Objectives: Cor triatriatum sinistrum (CTS and cor triatriatum dextrum (CTD are rare congenital anomalies characterized by the presence of a perforated septum which divides the respective atrium into a proximal and distal chamber. This report reviews the perioperative course of patients with uncorrected cor triatriatum (CT undergoing procedures requiring anesthesia. In addition, we performed a literature search that examines the experience of others regarding the peri-operative course of patients with CT. Materials and Methods: A computerized search of a medical record database was conducted to identify patients with a clinical diagnosis of uncorrected CTD and CTS undergoing surgical procedures. Descriptive statistics were used. Results: We identified 12 adult patients with asymptomatic CTS (n = 7 and CTD (n = 5 who underwent 23 anesthetics. There were no perioperative complications which could be attributed directly to the anatomy of CT. Conclusions: Our observation and review of the literature suggest that patients with asymptomatic CT typically tolerate anesthesia and surgical procedures well.

  20. Transverse myelitis following spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Jha Sanjeev

    2006-01-01

    Full Text Available Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 29-year-old male was referred with acute, flaccid, sensory motor paraplegia, with bladder and bowel involvement. He developed this immediately after an operation for inguinal hernia under spinal anesthesia. Spinal magnetic resonance imaging revealed hemorrhagic myelitis in the conus at D12. He was referred after he did not respond to intravenous methylprednisolone for 10 days. This case brings up the difficulty encountered in determination of the interspace used for spinal anesthesia and the potential for traumatic injury to the spinal cord. It also demonstrates the tragic outcome after a clinician violates some important, standard and established guidelines.

  1. Clinical relevance in anesthesia journals

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Møller, Ann M

    2006-01-01

    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles.......The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles....

  2. Consciousness fluctuation during general anesthesia: a theoretical approach to anesthesia awareness and memory modulation.

    Science.gov (United States)

    Cascella, Marco; Schiavone, Vincenzo; Muzio, Maria Rosaria; Cuomo, Arturo

    2016-08-01

    With anesthesia awareness as a model of study we debate the both fascinating and dangerous phenomenon called consciousness fluctuation that takes place during surgical anesthesia. In accordance with current scientific knowledge this paradox is the consequence of our limits in both precise knowledge of anesthesia mechanisms and our inability to accurately assess the level of anesthesia with brain monitoring. We also focus on the relationships between memory and anesthesia, as well as the possibility of interfering with memory during general anesthesia. PMID:27046232

  3. Marsupial, insectivore, and chiropteran anesthesia.

    Science.gov (United States)

    Pye, G W

    2001-01-01

    This article covers the manual restraint and anesthesia of marsupials, insectivores, and chiroptera. Marsupials commonly kept as pets in the U.S. [e.g., eastern gray kangaroos (Macropus giganteus), Bennett's wallabies (Macropus rufogriseus), and sugar gliders (Petaurus breviceps)] are covered in detail. Marsupial species kept in zoological parks [e.g., Tasmanian devils, koalas (Phascolarctos cinereus), and common wombats (Vombatus ursinus)] are covered in less detail. Of the insectivores, only the African hedgehog (Atelerix albiventris) and the European hedgehog (Erinaceus europaeus) are commonly kept as pets and, consequently, the insectivore section concentrates on discussing these two species. The section on chiropteran anesthesia is divided into two broad categories: the megachiropterans (flying foxes and fruit bats) and the microchiropterans (insectivorous bats). Most of the information on the species covered in this article is anecdotal, and this should be kept in mind when using the anesthesia protocols described. PMID:11217462

  4. Stabilizing membrane domains antagonizes anesthesia

    CERN Document Server

    Machta, Benjamin B; Nouri, Mariam; McCarthy, Nicola L C; Gray, Erin M; Miller, Ann L; Brooks, Nicholas J; Veatch, Sarah L

    2016-01-01

    Diverse molecules induce general anesthesia with potency strongly correlated both with their hydrophobicity and their effects on certain ion channels. We recently observed that several anesthetics inhibit heterogeneity in plasma membrane derived vesicles by lowering the critical temperature ($T_c$) for phase separation. Here we exploit conditions that stabilize membrane heterogeneity to test the correlation between the anesthetic potency of n-alcohols and effects on $T_c$. First we show that hexadecanol acts oppositely to anesthetics on membrane mixing and antagonizes ethanol induced anesthesia in a tadpole behavioral assay. Second, we show that two previously described `intoxication reversers' raise $T_c$ in vesicles and counter ethanol's effects in vesicles, mimicking the findings of previous electrophysiological measurements. Third, we find that hydrostatic pressure, long known to reverse anesthesia, also raises $T_c$ in vesicles with a magnitude that counters the effect of an anesthetic at relevant concen...

  5. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2009-01-01

    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of...... Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved by...

  6. Anesthesia for Children Having Eye Surgery

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Anesthesia for Children Having Eye Surgery En Español Read in Chinese What kinds of anesthesia are available for children having eye surgery? There ...

  7. Anesthesia for Adults Having Eye Surgery

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Anesthesia for Adults Having Eye Surgery En Español What kinds of anesthesia are available for adults having eye surgery? A “ ...

  8. Anesthesia Safe for Infants, Toddlers, Study Says

    Science.gov (United States)

    ... nlm.nih.gov/medlineplus/news/fullstory_159247.html Anesthesia Safe for Infants, Toddlers, Study Says No lingering ... 2016 TUESDAY, June 7, 2016 (HealthDay News) -- General anesthesia doesn't seem to harm young children's mental ...

  9. Back Pain and Neuraxial Anesthesia.

    Science.gov (United States)

    Benzon, Honorio T; Asher, Yogen G; Hartrick, Craig T

    2016-06-01

    The incidence of back pain after neuraxial anesthesia in the adult population is not different from that after general anesthesia. The pain is usually mild, localized in the low back, rarely radiates to the lower extremities, and has a duration of only a few days. The risk factors for development of back pain include the lithotomy position, multiple attempts at block placement, duration of surgery longer than 2.5 hours, body mass index ≥32 kg/m, and a history of back pain. However, there is no permanent worsening of preexisting back pain after neuraxial anesthesia. The back pain has been attributed to tears in the ligaments, fascia, or bone with localized bleeding; immobility of the spine; relaxation of the paraspinal muscles under anesthesia; flattening of the normal lumbar convexity; and stretching and straining of the lumbosacral ligaments and joint capsules. The addition of an anti-inflammatory drug to the local anesthetic used for skin infiltration may decrease the incidence and severity of back pain. The use of spinal or epidural anesthesia in the adult, non-obstetric and obstetric populations should depend on the advantages offered by the technique and not on the occurrence of back pain after the procedure. Additional studies are needed to confirm the efficacy of epidural dexamethasone, or other steroids, or the addition of an anti-inflammatory drug to the local anesthetic infiltration for the prevention of back pain after neuraxial anesthesia. Future studies should involve a physician with expertise in the evaluation of chronic low back pain to help identify the cause of the back pain and institute appropriate treatment(s). PMID:27195644

  10. The thermodynamics of general anesthesia

    CERN Document Server

    Heimburg, T; Heimburg, Thomas; Jackson, Andrew D.

    2006-01-01

    It is known that the action of general anesthetics is proportional to their partition coefficient in lipid membranes (Meyer-Overton rule). This solubility is, however, directly related to the depression of the temperature of the melting transition found close to body temperature in biomembranes. We propose a thermodynamic extension of the Meyer-Overton rule which is based on free energy changes in the system and thus automatically incorporates the effects of melting point depression. This model provides a quantitative explanation of the pressure reversal of anesthesia. Further, it explains why inflammation and the addition of divalent cations reduce the effectiveness of anesthesia.

  11. 21 CFR 868.6700 - Anesthesia stool.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room....

  12. Intestinal circulation during inhalation anesthesia

    International Nuclear Information System (INIS)

    This study was designed to evaluate the influence of inhalational agents on the intestinal circulation in an isolated loop preparation. Sixty dogs were studied, using three intestinal segments from each dog. Selected intestinal segments were pumped with aortic blood at a constant pressure of 100 mmHg. A mixture of 86Rb and 9-microns spheres labeled with 141Ce was injected into the arterial cannula supplying the intestinal loop, while mesenteric venous blood was collected for activity counting. A very strong and significant correlation was found between rubidium clearance and microsphere entrapment (r = 0.97, P less than 0.0001). Nitrous oxide anesthesia was accompanied by a higher vascular resistance (VR), lower flow (F), rubidium clearance (Cl-Rb), and microspheres entrapment (Cl-Sph) than pentobarbital anesthesia, indicating that the vascular bed in the intestinal segment was constricted and flow (total and nutritive) decreased. Halothane, enflurane, and isoflurane anesthesia were accompanied by a much lower arteriovenous oxygen content difference (AVDO2) and oxygen uptake than pentobarbital or nitrous oxide. Compared with pentobarbital, enflurane anesthesia was not accompanied by marked differences in VR, F, Cl-Rb, and Cl-Sph; halothane at 2 MAC decreased VR and increased F and Cl-Rb while isoflurane increased VR and decreased F. alpha-Adrenoceptor blockade with phentolamine (1 mg . kg-1) abolished isoflurane-induced vasoconstriction, suggesting that the increase in VR was mediated via circulating catecholamines

  13. Anesthesia and the developing brain

    DEFF Research Database (Denmark)

    Davidson, Andrew J; Becke, Karin; de Graaff, Jurgen;

    2015-01-01

    It is now well established that many general anesthetics have a variety of effects on the developing brain in animal models. In contrast, human cohort studies show mixed evidence for any association between neurobehavioural outcome and anesthesia exposure in early childhood. In spite of large...

  14. Periocular Anesthesia in Aesthetic Surgery

    OpenAIRE

    Skibell, Bentley C.; Soparkar, Charles N.S.; Tower, Robert N.; Patrinely, James R.

    2007-01-01

    This article focuses on the administration of anesthesia for periocular aesthetic procedures. Special emphasis is given to office-based procedures, most often without any systemic sedation, highlighting the importance of open communication with patients. Finally, attention is given to potential pitfalls including anesthetic systemic toxicity, ocular injuries, and orbicularis myotoxicity.

  15. 以客户需求为导向的企业销售团队订单闭环管理%Close Circuit Management of The Customer-Demand Oriented Team Order in the Corporate Sales Team

    Institute of Scientific and Technical Information of China (English)

    费天翔

    2016-01-01

    It is of great necessity that the close circuit management be implemented in order to effectively attract and fin-ish orders.After a general description of the close circuit management of the corporate orders of sales team,the commonly found problems are analyzed:such as the construction of the sales team,the difficulty of frequent change in demand,the une-ven asymmetry of delivery date information.And corresponding counter measures are put forth:top priority be given to the construction of sales team;timely knowledge of the information change be learned concerning demand side and the productive links;the communication be strengthened between the sales section and the stock management section so that the productive efficiency and sales performance could be promoted.%为制造企业承揽并有效率的完成订单,其销售团队实行闭环管理很有必要。为此,在对销售团队订单闭环管理进行概述的基础上,分析了订单闭环管理中容易出现的问题:销售团队的建设、订单需求变化频繁的困境、交货期信息不对称,由此提出的对策是:高度重视销售团队的建设,及时掌握并反馈需求侧和生产环节的变化信息,加强销售部门与库存管理部门的联系沟通,从而提高生产效率和销售业绩。

  16. History of anesthesia in Germany.

    Science.gov (United States)

    Wawersik, J

    1991-01-01

    The first ether anesthetic was administered in Germany by J.F. Heyfelder (1798-1869) at the Erlangen University Hospital on January 24, 1847. Thereafter, famous discoveries occurred in the field of pharmacology. Albert Niemann isolated cocaine from the coca shrub in 1860; Emil Fischer synthesized the first barbiturate, Veronal, in 1902; and Helmut Weese promoted the first ultra-short-acting barbiturate, hexobarbital (Evipan), in 1932. The local anesthetic effect of cocaine was reported by Koller at the Congress of the German Society for Ophthalmology on September 15, 1884, in Heidelberg. Many new techniques were tried first in German hospitals. Friedrich Trendelenburg carried out, by tracheotomy, the first operation with endotracheal intubation in 1869, and Franz Kuhn promoted and clinically practiced endotracheal intubation in Heidelberg beginning in 1900. August Bier performed the first operation under spinal anesthesia at the Kiel University Hospital on August 16, 1898. Carl Ludwig Schleich (1859-1922) standardized the methods of infiltration anesthesia by using a cocaine solution in sufficient dilution. The development of anesthesia machines was greatly influenced by Heinrich Dräger (1847-1917) and his son Bernhard Dräger (1870-1928). The Dräger Company in Lübeck built the first anesthesia machine with a carbon dioxide (CO2) absorber and circle system in 1925. Paul Sudeck and Helmut Schmidt worked with this system at the Hamburg University Hospital and reported their results in 1926. The first Dräger anesthesia machine was produced in 1902 and introduced into clinical use by Otto Roth (1863-1944) in Lübeck. Before the Second World War, three universities in Germany carried out research in the field of anesthesia: the University of Freiburg with H. Killian, the University of Hamburg with P. Sudeck and H. Schmidt, and the University of Würzburg with C.G. Gauss. Killian and Gauss established the first journals, Der Schmerz and Narkose und Anaesthesie, in

  17. Psychological aspects of pediatric anesthesia

    Directory of Open Access Journals (Sweden)

    Drašković Biljana

    2015-01-01

    Full Text Available Surgery and anesthesia cause a significant emotional stress in both parents and children. Since the consequences of this stress develop immediately after surgery and can last even when the hospital treatment is over, the role of the anesthesiologist is to ensure psychological as well as physiological well-being of the patient. In order to reduce emotional stress induced by anesthesia and operation, the anesthesiologist has to understand certain developmental phases that children go through and to identify situations which a child could potentially see as a danger or a threat. This can usually be achieved by careful preoperative assessment and by administering preoperative sedation. During the preoperative visit to the patient, the anesthesiologist can evaluate the levels of anxiety of both parents and children as well as assess the child’s medical condition.

  18. The elderly and general anesthesia

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2010-01-01

    Due to the aging population, the number of elderly patients taking advantage of healthcare services is increasing. A general physical decline of all organ systems and a high frequency of chronic disease accompanying aging.Comorbidity and polypharmacy are therefore common in the elderly. Hence, the...... administration of general anesthesia to the elderly can be a very challenging task. This paper aims to highlight some of the important issues presented to the elderly undergoing surgery and to suggest some strategies for management....

  19. SPLIT SKIN GRAFT HARVESTING UNDER LOCAL ANESTHESIA INFILTRATION VERSUS TOPICAL LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Shahi

    2014-04-01

    Full Text Available OBJECTIVE: To compare the effectiveness of topical local anesthesia using PRILOX cream versus local anesthesia infiltration using lignocaine and adrenaline in harvesting split skin graft. METHODS: A prospective study of 58 patients requiring split skin graft was carried. One group comprising 29 patients underwent harvesting of split skin graft under topical local anesthesia using PRILOX cream while the other group had local anesthesia infiltration using lignocaine and adrenaline. RESULTS: There were no significant differences between the 2 groups in terms of operating time, per operative pain, post-operative pain and post-operative requirement of analgesia. There was significant difference in time and pain during administration of local anesthesia and patient’s acceptability/ satisfaction with method of anesthesia. CONCLUSION: Topical local anesthesia using PRILOX cream can be used effectively for harvesting of split skin graft and is good alternative to local anesthesia infiltration.

  20. Survey of international regional anesthesia fellowship directors

    OpenAIRE

    Lansdown AK; McHardy PG; Patel SC; Nix CM; McCartney CJL

    2013-01-01

    Andrew K Lansdown,1,2 Paul G McHardy,1 Sanjiv C Patel,1,3 Catherine M Nix,1 Colin JL McCartney1 1Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Sydney, Sydney, NSW, Australia; 3University College Hospital, London, UK Background: The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods: Regional anesthesia fellowship ...

  1. Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature

    OpenAIRE

    2015-01-01

    Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, ...

  2. General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy

    OpenAIRE

    Lucía Vizcaíno-Martínez; Manuel Ángel Gómez-Ríos; Beatriz López-Calviño

    2014-01-01

    Objective: The aim was to evaluate general anesthesia (GA) plus ilioinguinal nerve block (IIB) versus spinal anesthesia (SA) in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, main...

  3. Assessing pain responses during general anesthesia.

    Science.gov (United States)

    Stomberg, M W; Sjöström, B; Haljamäe, H

    2001-06-01

    Major technical and pharmacological achievements in recent years have greatly influenced the practice of anesthesia. Clinical signs related to the main aspects of anesthesia, i.e., hypnosis, analgesia, and muscular relaxation, are increasingly obtainable from variables supplied by the monitoring equipment. It is not known, however, to what extent more indirect, patient-associated clinical signs of pain/depth of anesthesia are still considered of importance and relied on in the intraoperative management of surgical patients. The aims of the present study were to assess what clinical signs, indirect as well as monitor-derived, are considered indicative of intraoperative pain or depth of anesthesia by nurse anesthetists during general anesthesia. In connection with anesthetic management of surgical patients, Swedish nurse anesthetists (N = 40) were interviewed about clinical signs that they routinely assessed and were asked if the observed signs were considered indicative mainly of intraoperative pain or depth of anesthesia. It was found that skin-associated responses (temperature, color, moisture/stickiness) were commonly considered to indicate intraoperative pain rather than depth of anesthesia. Respiratory movements, eye reactions, and circulatory responses were considered to be indicative of either pain or insufficient depth of anesthesia. The present data indicate that indirect physiological signs are still considered of major importance by anesthesia nurses during the anesthetic management of surgical patients. PMID:11759565

  4. On-chip constructive cell-network study (II: on-chip quasi-in vivo cardiac toxicity assay for ventricular tachycardia/fibrillation measurement using ring-shaped closed circuit microelectrode with lined-up cardiomyocyte cell network

    Directory of Open Access Journals (Sweden)

    Yasuda Kenji

    2011-09-01

    Full Text Available Abstract Backgrounds Conventional in vitro approach using human ether-a-go-go related gene (hERG assay has been considered worldwide as the first screening assay for cardiac repolarization safety. However, it does not always oredict the potential QT prolongation risk or pro-arrhythmic risk correctly. For adaptable preclinical strategiesto evaluate global cardiac safety, an on-chip quasi-in vivo cardiac toxicity assay for lethal arrhythmia (ventricular tachyarrhythmia measurement using ring-shaped closed circuit microelectrode chip has been developed. Results The ventricular electrocardiogram (ECG-like field potential data, which includes both the repolarization and the conductance abnormality, was acquired from the self-convolutied extracellular field potentials (FPs of a lined-up cardiomyocyte network on a circle-shaped microelectrode in an agarose microchamber. When Astemisol applied to the closed-loop cardiomyocyte network, self-convoluted FP profile of normal beating changed into an early afterdepolarization (EAD like waveform, and then showed ventricular tachyarrhythmias and ventricular fibrilations (VT/Vf. QT-prolongation-like self-convoluted FP duration prolongation and its fluctuation increase was also observed according to the increase of Astemizole concentration. Conclusions The results indicate that the convoluted FPs of the quasi-in vivo cell network assay includes both of the repolarization data and the conductance abnormality of cardiomyocyte networks has the strong potential to prediction lethal arrhythmia.

  5. Neonatal anesthesia with limited resources.

    Science.gov (United States)

    Bösenberg, Adrian T

    2014-01-01

    Neonates are the most vulnerable age group in terms of anesthetic risk and perioperative mortality, especially in the developing world. Prematurity, malnutrition, delays in presentation, and sepsis contribute to this risk. Lack of healthcare workers, poorly maintained equipment, limited drug supplies, absence of postoperative intensive care, unreliable water supplies, or electricity are further contributory factors. Trained anesthesiologists with the skills required for pediatric and neonatal anesthesia as well as basic monitoring equipment such as pulse oximetry will go a long way to improve the unacceptably high anesthetic mortality. PMID:24251423

  6. Local anesthesia for prostate brachytherapy

    International Nuclear Information System (INIS)

    Purpose: To demonstrate the technique and feasibility of prostate brachytherapy performed with local anesthesia only. Methods and Materials: A 5 by 5 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 cc of 1% lidocaine with epinephrine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 cc lidocaine solution with approximately 8 passes of a 20-gauge 1.0-inch needle. Following subcutaneous and peri-apical lidocaine injections, the patient is brought to the simulator suite and placed in leg stirrups. The transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6.0-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 cc of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn, for a total volume of 15 cc. The implants are done with a Mick Applicator, inserting and loading groups of two to four needles, so that a maximum of only about four needles are in the patient at any one time. During the implant procedure, an additional 1 cc of lidocaine solution is injected into one or more needle tracks if the patient experiences substantial discomfort. The total dose of lidocaine is generally limited to 500 mg (50 ml of 1% solution). Results: To date, we have implanted approximately 50 patients in our simulator suite, using local anesthesia. Patients' heart rate and diastolic blood pressure usually showed moderate changes, consistent with some discomfort. The time from first subcutaneous injection and completion of the source insertion ranged from 35 to 90 minutes. Serum lidocaine levels were below or at the low range of therapeutic. There has been only one instance of acute urinary retention in the

  7. [Voluntary interruption of pregnancy: anesthesia or sophrology].

    Science.gov (United States)

    Ferragut, E

    1979-10-01

    General anesthesia during induced abortion has the great advantage of eliminating any physical pain; it does not do anything, however, for anxiety, guilt feeling, emotional upheaval, and postoperative depression. This study investigate sophrology, a form of anesthesia without medication, which diminishes psychic tension through comforting and sympathetic words, and corporal tension through relaxation. At the beginning of the study, which observed 7547 patients, general anesthesia was routinely used for all induced abortion patients; after 4 years of observation, general anesthesia was used on about 1.9% of patients. Judging from a questionnaire given to patients after intervention 75% of patients were completely satisfied from an emotional point of view; the same percentage judged the procedure a bit painful, but bearable; only 3.5% of patients regretted not to have opted for general anesthesia. PMID:12158285

  8. Anesthesia

    Science.gov (United States)

    ... of external growths. Although alcohol, opium or other botanicals sometimes helped alleviate the agony, most surgical patients ... of the population, such as the elderly or cancer survivors, will reveal whether certain anesthetics are better ...

  9. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger; Krøigaard, Mogens; Belhage, Bo; Husum, Bent; Poulsen, Lars K

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study was to...... investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis....

  10. Supplemental pulpal anesthesia for mandibular teeth

    Directory of Open Access Journals (Sweden)

    Thangavel Boopathi

    2013-01-01

    Full Text Available Clinical pulpal anesthesia is dependent on the interaction of three major factors. (1 the dentist (2 the patient and (3 local anesthesia. Many patients fear endodontic treatment due to a concern about pain. Although pain treatment is well managed in many endodontic patients, there exists a group of patients who do not receive adequate local anesthesia. The purpose of this review article is to discuss the possible reasons for pulpal anesthetic failures and also to focus on the measures for developing effective approaches for the same.

  11. Path-analysis on Opening and Closing Circuit of GW4 Disconnector and Optimization Improvements%GW4型隔离开关产品分合闸轨迹分析及优化改进措施

    Institute of Scientific and Technical Information of China (English)

    常林晶; 徐光辉; 乔岩泽; 刘佳春

    2013-01-01

    During the process of the on-site commission and maintenance of GW4 disconnector unperfected in earlier time, the following phenomena happen sometimes: The left and right contacts couldn' t be properly engaged; operating torque was large; there was unilateral compression on contact finger after closing; conducting arms on the left and right sides were not parallel after opening. On the basis of path-analysis on opening and closing circuit of GW4 disconnector, this paper reveals the relationship between these phenomena and the distribution proportion of the following parts: the length and initial angle of active crank and passive crank, the length of cross bar linkage, and the length of left and right conducting arm, and proposes the optimized initial angle of transmission crank, the length for fixing the cross bar linkage, and the optimization improvements for reasonable distribution of the length of left and right conducting arm.%早期未完善的GW4型隔离开关产品在现场调试和维护过程中,有时会出现左、右触头不能正常啮合,操作力矩大,合闸后触指单侧压紧,分闸后左右两侧导电臂不平行等现象,笔者对GW4型隔离开关产品的分合闸轨迹进行了分析,在此基础上揭示了传动底座上主动拐臂和从动拐臂的长度及起始角度、交叉连杆的长度、左右导电臂长度的分配比例与上述现象之间的关系,并提出了优化选择传动拐臂的起始角度,固定交叉连杆的长度,合理分配左右导电臂长度的改进措施.

  12. Anesthesia related Complications in Pediatric GI Endoscopy

    Directory of Open Access Journals (Sweden)

    A Sabzevari

    2014-04-01

    Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in   children undergoing elective GI endoscopy.   Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data  ,  location of GI endoscopy ,  perioperative vital singe ,  recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome   Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication.  6 patients (0.4% have post operative agitation controlled by medication.   Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

  13. Anaphylaxis due to thiopental sodium anesthesia.

    OpenAIRE

    Dolovich, J; Evans, S.; Rosenbloom, D; Goodacre, R; Rafajac, F O

    1980-01-01

    Anaphylaxis due to an anesthetic is one type of cardiovascular emergency that can occur during general anesthesia. Anaphylactic reactions to muscle relaxants have been documented. Barbiturates, used as sedatives, are well known to produce cutaneous reactions, but anaphylaxis after their ingestion seems to be rare. Generalized allergic reactions to thiopental sodium during anesthesia are mentioned in the product monograph for Penthothal sodium, and rare case reports of anaphylactic reactions t...

  14. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  15. Acupuncture assisted local anesthesia for penile surgeries

    OpenAIRE

    Hsu, Geng-Long; Zaid, Uwais X.; Hsieh, Cheng-Hsing; Huang, Sheng-Jean

    2013-01-01

    Although the mechanism of acupuncture for analgesia is not fully elucidated, a combination of acupuncture and several methods of topical blocks for local anesthesia has been effective to patients with indications for penile surgeries on ambulatory basis. We sought to review this unique clinical application since 1998. To summarize practice-based medical literature contingent this unique application and, in contrast, the commonly agreed either general or spinal anesthesia concerning those surg...

  16. Methylphenidate Actively Induces Emergence from General Anesthesia

    OpenAIRE

    Solt, Ken; Cotten, Joseph F.; Cimenser, Aylin; Wong, Kin F.K.; Chemali, Jessica J.; Brown, Emery N.

    2011-01-01

    Background: Although accumulating evidence suggests that arousal pathways in the brain play important roles in emergence from general anesthesia, the roles of monoaminergic arousal circuits are unclear. In this study, the authors tested the hypothesis that methylphenidate (an inhibitor of dopamine and norepinephrine transporters) induces emergence from isoflurane general anesthesia. Methods: Using adult rats, the authors tested the effect of intravenous methylphenidate on time to emergence...

  17. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  18. Reductions in anesthesia direct costs is not the right way for racionalization of anesthesia costs

    Directory of Open Access Journals (Sweden)

    Majstorović Branislava M.

    2012-01-01

    Full Text Available Introduction. Anesthesia management is characterized by salary limiting and pressure for decreasing anesthetics and other drug budget. The aim of this paper is to determine the possibility of reducing the direct costs in anesthesia. Materials and methods. This paper is a part of a five-year (2005-2009, academic, pharmaco-economic retrospective- prospective study (phase IV. The study was done according to European Union Directive for Clinical Research. We retrospectively calculated and analyzed all anesthesia direct costs (personnel costs, anesthetics and other drug costs, materials, laboratory analyses, and machines at the Institute For Ane- sthesia and Reanimation, Clinical Center of Serbia in relation to the costs refunded by National Health Insurance in all patients who underwent anesthesia in 2006. Results. Out of 70 195 anesthesia services rendered to 32 267 patients in one-year period, 47% were general anesthesia, 23% were local anesthesia, and 30% were anesthetic procedures. Our results of highly significant association between personnel costs (r = 0.980, p = 0.000 and consumption of anesthetics and drugs (r = 0.885, p = 0.000 with the direct costs do not provide an opportunity for further cost reduction due to disassociation of direct costs and the ”unit price” of National Health Insurance issued in terms of the restricted maximum budget for health. Conclusion. There is no space for direct cost reduction in anesthesia.

  19. General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy

    OpenAIRE

    Yousef, Gamal T.; Lasheen, Ahmed E.

    2012-01-01

    Background: Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. Objective: This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery an...

  20. Minimally invasive parathyroidectomy under local anesthesia

    Directory of Open Access Journals (Sweden)

    Ö Karahan

    2013-01-01

    Full Text Available Background: More than 85% of primary hyperparathyroidism (PHPT cases are due to solitary, benign parathyroid adenomas. Recently, the success rate of Tc99m sestamibi scintigraphy in localization has made minimally invasive parathyroidectomy (MIP more prominent. MIP is as effective as conventional bilateral neck exploration. Moreover, it offers lower morbidity, cost effectiveness, and better cosmetics effects. Aim: We aimed to evaluate the success of MIP, which happens only under local anesthesia, in this study. Materials and Methods: Total of 63 patients were operated for PHPT, of which 54 had solitary adenoma. Five patients underwent bilateral neck exploration under general anesthesia for thyroid nodules or unlocalizated adenomas. A total of 49 patients underwent MIP under local anesthesia without any sedation. During MIP, gamma probe was used for all patients. The patients were followed for parathyroid functions. Results: The mean age of 49 patients with MIP (5 male, 44 female was 59 years. The mean follow-up time was 16.4 (±10.1 months (range: 2-36 months. Of the 49 patients, 47 (96% were totally cured. In 2 patients, the procedure was switched to conventional bilateral neck exploration. Temporary hypocalcaemia was noted in 4 patients. Conclusions: If the adenoma is localizated, MIP under only local anesthesia can be performed with a high success rate. Gamma probe-guided MIP under local anesthesia is an effective and safe method. It has the advantage of being minimally invasive and, therefore, it should be preferred over the conventional method.

  1. Survey of international regional anesthesia fellowship directors

    Directory of Open Access Journals (Sweden)

    Lansdown AK

    2013-07-01

    Full Text Available Andrew K Lansdown,1,2 Paul G McHardy,1 Sanjiv C Patel,1,3 Catherine M Nix,1 Colin JL McCartney1 1Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Sydney, Sydney, NSW, Australia; 3University College Hospital, London, UK Background: The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods: Regional anesthesia fellowship directors across the world were asked to complete a comprehensive survey that detailed the range of educational and practical experience and attitudes as well as assessment procedures offered in their programs. Results: The survey response rate was 66% (45/68. Overall, the range of activities and the time and resources committed to education during fellowships is encouraging. A wide range of nerve block experience is reported with most programs also offering acute pain management, research, and teaching opportunities. Only two-thirds of fellowships provide formal feedback. This feedback is typically a formative assessment. Conclusion: This is the first survey of regional anesthesia fellowship directors, and it illustrates the international scope and continuing expansion of education and training in the field. The results should be of interest to program directors seeking to benchmark and improve their educational programs and to faculty involved in further curriculum development. Keywords: anesthesia, regional, fellowship, education

  2. [Rapid opiate detoxification under anesthesia (RODA)].

    Science.gov (United States)

    Dubols, N; Hallet, C; Luppens, D; Ansseau, M; Charlier, C

    2013-01-01

    Rapid Opiate Detoxification under Anesthesia (RODA) involves the use of opiate antagonists combined with anesthesia and pharmacotherapy to reduce withdrawal symptoms. The aim of our study was to measure the plasma concentrations of heroin metabolites and methadone during anesthesia and patient stay at the hospital in order to assess the amount of active substances at each protocol step. Plasma concentrations of antagonists were also quantified and compared to the recommended target values. Blood samples were drawn in 10 patients undergoing RODA at different times of the procedure (during anesthesia, in post-anesthesia care unit and in psychiatry unit). The plasma concentrations of heroin metabolites, methadone and antagonists were measured using a previously described method. Heroin active metabolites were no longer detected in the patient blood when helshe left the hospital; by contrast, methadone was still present at significant concentrations 3 days after the beginning of the detoxification procedure. Naltrexone analysis allowed us to adjust doses to insure opiate receptor blockade during acute withdrawal, which is a critical period. PMID:23888580

  3. Pediatric regional anesthesia- A comparison between pediatric spinal and caudal anesthesia

    Directory of Open Access Journals (Sweden)

    Charu Pandya

    2014-01-01

    Full Text Available Regional anesthesia in children was first studied by August Bier in 1899. Since then, spinal anesthesia was known to be practiced for several years with a series of cases published as early as in 1909-1910. (1 In 1900, Bainbridge reported a case of strangulated hernia repair under spinal anesthesia in an infant of three months(2. Thereafter, Tyrell Gray, a British surgeon published a series of 200 cases of lower abdominal surgeries in infants and children under spinal anesthesia in 1909-1910. The appearance of neuromuscular blocking agents and the development of volatile anesthetics in the forties shifted the techniques toward general anesthesia. However, spinal pediatric anesthesia did not disappear. In 1901, Sicard and Cathelin introduced independently the caudal approach in the anesthetic practice. The first publication that mentions this technique in children was written by Campbell in 1933 and the second one by Leigh and Belton in 1951. Subsequently, Fortuna (1963 in Brazil, Melman(10 (1973 in Mexico, Takasaki (1977 in Japan, Ecoffey(7 (1985 in France, and Rash (1995 in USA, introduced these techniques in their countries. The caudal technique is extensively described by Key in 1994. When regional anesthesia is given to older children, some variables such as the intervention site, age, and presence of chronic disease, cooperativeness and parental preferences should be considered. In present study we compared caudal block with spinal block in pediatric patients.

  4. Transient Neurological Symptoms after Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Zehra Hatipoglu

    2013-02-01

    Full Text Available Lidocaine has been used for more than 50 years for spinal anesthesia and has a remarkable safety record. In 1993, a new adverse effect, transient neurologic toxicity was described in patients recovering from spinal anesthesia with lidocaine. Transient neurological symptoms have been defined as pain in the lower extremities (buttocks, thighs and legs after an uncomplicated spinal anesthesia and after an initial full recovery during the immediate postoperative period (less than 24 h. The incidence of transient neurological symptoms reported in prospective, randomized trials varies from 4% to 37%. The etiology of transient neurological symptoms remains unkonwn. Despite the transient nature of this syndrome, it has proven to be difficult to treat effectively. Drug or some interventional therapy may be necessary. [Archives Medical Review Journal 2013; 22(1.000: 33-44

  5. After Anesthesia: The Patient's Active Role Assists in Recovery

    Science.gov (United States)

    ... after—an anesthetic is given. Before anesthesia, a preoperative interview with your anesthesia professional supplies valuable information ... to your mental state as well. Moreover, the anxiety that frequently accompanies important decisions is to be ...

  6. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    Science.gov (United States)

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use. PMID:27003489

  7. Convulsions during cataract surgery under peribulbar anesthesia: a case report

    OpenAIRE

    Bensghir, Mustapha; Badou, Najlae; Houba, Abdelhafid; Balkhi, Hicham; Haimeur, Charki; Azendour, Hicham

    2014-01-01

    Introduction Locoregional anesthesia techniques are increasingly used for cataract surgery. From these techniques, peribulbar anesthesia has been very successful over the retrobulbar anesthesia seen its effectiveness and safety. However, peribulbar anesthesia is not without risk. Case presentation A 70-year-old African man was scheduled for cataract surgery and lens implant for his right eye. His medical history included hypertension, diabetes mellitus and gall bladder surgery. There were no ...

  8. Phrenic nerve blocage with spinal anesthesia for laparoscopic Nissen fundoplication

    Directory of Open Access Journals (Sweden)

    Murat Dursun

    2015-06-01

    Full Text Available In this case, we describe a patient having laparoscopic Nissen fundoplication (LNF under spinal anesthesia with phrenic nerve blockade. It’s emphasized that in this type of operations, spinal anesthesia may be an alternative method rather the general anesthesia and the resulting shoulder pain in laparoscopic surgery performed under spinal anesthesia can be prevented by phrenic nerve blockade. J Clin Exp Invest 2015; 6 (2: 186-188

  9. Anesthesia for pediatric external beam radiation therapy

    International Nuclear Information System (INIS)

    Background: For very young patients, anesthesia is often required for radiotherapy. This results in multiple exposures to anesthetic agents over a short period of time. We report a consecutive series of children anesthetized for external beam radiation therapy (EBRT). Methods: Five hundred twelve children ≤ 16 years old received EBRT from January 1983 to February 1996. Patient demographics, diagnosis, anesthesia techniques, monitoring, airway management, complications, and outcome were recorded for the patients requiring anesthesia. Results: One hundred twenty-three of the 512 children (24%) required 141 courses of EBRT with anesthesia. Anesthetized patients ranged in age from 20 days to 11 years (mean 2.6 ± 1.8 ). The frequency of a child receiving EBRT and requiring anesthesia by age cohort was: ≤ 1 year (96%), 1-2 years (93%), 2-3 years (80%), 3-4 years (51%), 4-5 years (36%), 5-6 years (13%), 6-7 years (11%), and 7-16 years (0.7%). Diagnoses included: primary CNS tumor (28%), retinoblastoma (27%), neuroblastoma (20%), acute leukemia (9%), rhabdomyosarcoma (6%), and Wilms' tumor (4%). Sixty-three percent of the patients had been exposed to chemotherapy prior to EBRT. The mean number of anesthesia sessions per patient was 22 ± 16. Seventy-eight percent of the treatment courses were once daily and 22% were twice daily. Anesthesia techniques included: short-acting barbiturate induction + inhalation maintenance (21%), inhalation only (20%), ketamine (19%), propofol only (12%), propofol induction + inhalation maintenance (7%), ketamine induction + inhalation maintenance (6%), ketamine or short-acting barbiturate induction + inhalation maintenance (6%). Monitoring techniques included: EKG (95%), O2 saturation (93%), fraction of inspired O2 (57%), and end-tidal CO2 (55%). Sixty-four percent of patients had central venous access. Eleven of the 74 children with a central line developed sepsis (15%): 6 of the 11 were anesthetized with propofol (55%), 4 with a short

  10. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to...

  11. 21 CFR 868.5170 - Laryngotracheal topical anesthesia applicator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Laryngotracheal topical anesthesia applicator. 868... topical anesthesia applicator. (a) Identification. A laryngotracheal topical anesthesia applicator is a device used to apply topical anesthetics to a patient's laryngotracheal area. (b) Classification....

  12. Nurse Anesthetists' Perceptions Regarding Utilization of Anesthesia Support Personnel

    Science.gov (United States)

    Ford, Mary Bryant

    2010-01-01

    Anesthesia support personnel (ASP) provide direct support to health care providers administering anesthesia (Certified Registered Nurse Anesthetists [CRNAs] and anesthesiologists). Because these anesthesia providers are caring for a patient whom they cannot legally or ethically leave unattended, ASP are employed to bring them extra supplies or…

  13. 21 CFR 868.5140 - Anesthesia conduction kit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction kit. 868.5140 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5140 Anesthesia conduction kit. (a) Identification. An anesthesia conduction kit is a device used to administer to a patient conduction, regional,...

  14. 21 CFR 868.5130 - Anesthesia conduction filter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction filter. 868.5130 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5130 Anesthesia conduction filter. (a) Identification. An anesthesia conduction filter is a microporous filter used while administering to a...

  15. 21 CFR 868.5150 - Anesthesia conduction needle.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction needle. 868.5150 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5150 Anesthesia conduction needle. (a) Identification. An anesthesia conduction needle is a device used to inject local anesthetics into a patient...

  16. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  17. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger;

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study was to inve...

  18. 21 CFR 884.5100 - Obstetric anesthesia set.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly...

  19. [Comparative assessment of inhalation anesthesia with sevofluran and intravenous anesthesia with propofol for carotid endarterectomy].

    Science.gov (United States)

    Neĭmark, M I; Shmelev, V V; Simagin, V Iu

    2009-01-01

    Total intravenous anesthesia with propofol and inhalation sevofluran was assessed in 130 patients with carotid endarterectomy. The parameters of brain blood circulation, brain damage markers were studied. It was shown that sevofluran anesthesia caused less depression of the hemodynamic parameters, supported more optimum level of brain blood flow that limited ischemic and reperfusion damage of the brain and was accompanied by a fewer number of postoperative complications. PMID:20209996

  20. General anesthesia for horses with specific problems

    International Nuclear Information System (INIS)

    We have discussed anesthetic techniques, special considerations, and expected complications involved in anesthetizing horses for abdominal, orthopedic, and head and neck surgery, and myelography and have described expected physiologic dysfunction that may require changes in anesthetic technique or supportive measures. The objective is high-quality patient care and reduction in anesthesia-related morbidity and death

  1. The Biochemical Impact of Surgery and Anesthesia

    NARCIS (Netherlands)

    J.W. Hol (Jaap Willem)

    2014-01-01

    markdownabstract__Abstract__ General anesthesia has been considered by some medical historians as one of the most important contributions to modern medicine second to perhaps the concept of antiseptic medicine and hygiene. The first historical mention of a deep unnatural sleep so that surgery can t

  2. 42 CFR 415.178 - Anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Anesthesia services. 415.178 Section 415.178 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING...

  3. Testing haptic sensations for spinal anesthesia.

    LENUS (Irish Health Repository)

    2011-01-01

    Having identified key determinants of teaching and learning spinal anesthesia, it was necessary to characterize and render the haptic sensations (feeling of touch) associated with needle insertion in the lower back. The approach used is to match recreated sensations (eg, "pop" through skin or dura mater) with experts\\' perceptions of the equivalent clinical events.

  4. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding on the...

  5. Update on complications in pediatric anesthesia

    Directory of Open Access Journals (Sweden)

    Giovanni de Francisci

    2013-02-01

    Full Text Available Complications in pediatric anesthesia can happen, even in our modern hospitals with the most advanced equipment and skilled anesthesiologists. It is important, albeit in a tranquil and reassuring way, to inform parents of the possibility of complications and, in general, of the anesthetic risks. This is especially imperative when speaking to the parents of children who will be operated on for minor procedures: in our experience, they tend to think that the anesthesia will be a light anesthesia without risks. Often the surgeons tell them that the operation is very simple without stressing the fact that it will be done under general anesthesia which is identical to the one we give for major operations. Different is the scenario for the parents of children who are affected by malignant neoplasms: in these cases they already know that the illness is serious. They have this tremendous burden and we choose not to add another one by discussing anesthetic risks, so we usually go along with the examination of the child without bringing up the possibility of complications, unless there is some specific problem such as a mediastinal mass.

  6. [Anesthesia in the Signal Processing Methods].

    Science.gov (United States)

    Gu, Jiajun; Huang, Yan; Ye, Jilun; Wang, Kaijun; Zhang, Meimei

    2015-09-01

    Anesthesia plays an essential role in clinical operations. Guiding anesthesia by EEG signals is one of the most promising methods at present and it has obtained good results. The analysis and process of the EEG signals in anesthesia can provide clean signal for further research. This paper used variance threshold method to remove the mutation fast and large interfering signals; and used notch filter to remove frequency interference, smoothing filter to remove baseline drift and Butterworth low-pass filter to remove high frequency noise at the same time. In addition to this, the translation invariant wavelet method to remove interference noise on the signals which was after the classical filter and retained non-stationary characteristics was used to evaluate parameter calculation. By comparing the calculated parameters from treated signal using this paper's methods and untreated signal and standard signal, the standard deviation and correlation has been improved, particularly the major parameters BetaR, which provides better signal for integration of multi-parameter to evaluate depth of anesthesia index for the latter. PMID:26904870

  7. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  8. Respiratory Monitoring for Anesthesia and Sedation

    OpenAIRE

    Anderson, Jay A.

    1987-01-01

    This article reviews the theory and practice of routine respiratory monitoring during anesthesia and sedation. Oxygen monitoring and capnography methods are reviewed. The current ventilation monitoring system of choice is considered a combination of the pulse oximeter and capnography. Guidelines are provided for monitoring standards.

  9. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding on the...

  10. A Wavelet Transform Based Method to Determine Depth of Anesthesia to Prevent Awareness during General Anesthesia

    Directory of Open Access Journals (Sweden)

    Seyed Mortaza Mousavi

    2014-01-01

    Full Text Available Awareness during general anesthesia for its serious psychological effects on patients and some juristically problems for anesthetists has been an important challenge during past decades. Monitoring depth of anesthesia is a fundamental solution to this problem. The induction of anesthesia alters frequency and mean of amplitudes of the electroencephalogram (EEG, and its phase couplings. We analyzed EEG changes for phase coupling between delta and alpha subbands using a new algorithm for depth of general anesthesia measurement based on complex wavelet transform (CWT in patients anesthetized by Propofol. Entropy and histogram of modulated signals were calculated by taking bispectral index (BIS values as reference. Entropies corresponding to different BIS intervals using Mann-Whitney U test showed that they had different continuous distributions. The results demonstrated that there is a phase coupling between 3 and 4 Hz in delta and 8-9 Hz in alpha subbands and these changes are shown better at the channel T7 of EEG. Moreover, when BIS values increase, the entropy value of modulated signal also increases and vice versa. In addition, measuring phase coupling between delta and alpha subbands of EEG signals through continuous CWT analysis reveals the depth of anesthesia level. As a result, awareness during anesthesia can be prevented.

  11. Comparison of Anesthesia Quality for Arthroscopic Knee Surgery: Combined Sciatic Femoral Block and Unilateral Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Sinem Sarı

    2015-08-01

    Full Text Available Objective: We aimed to evaluate the quality of anesthesia of combined sciatic and femoral 3-in-1 nerve blocks (CSFB and unilateral spinal anesthesia technique with low-dose levobupivacaine in outpatients undergoing knee arthroscopy surgery. Materials and Methods: Forty American Society of Anesthesiologists (ASA physical status I-II patients were randomly allocated into two groups and unilateral spinal anesthesia with low-dose levobupivacaine (group S, n=20 or CSFB (group B, n=20 was performed. Besides the quality of anesthesia, anesthetic effectiveness, hemodynamic values, duration of the technique application, maximum motor and sensorial block levels and durations, the first analgesics need, and total analgesic consumptions during postoperative 24 hours and determined complications were compared between the two groups. Results: The quality of anesthesia was better in group S, no patient received either sedation or analgesic intraoperatively while first analgesic need and number of patient was higher (p=0.014, p<0.001, p=0.032 respectively. The duration of technical application was shorter while maximum motor and sensorial block levels were higher in group S (p<0.0001, p=0.008, p<0.001 respectively. Motor block duration was significantly longer in group B (p<0.0001. Conclusion: We concluded that CSFB practice is an effective anesthetic alternative for unilateral spinal anesthesia. Introduction

  12. Chest CT in children: anesthesia and atelectasis

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

    2014-02-15

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  13. Chest CT in children: anesthesia and atelectasis

    International Nuclear Information System (INIS)

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  14. Role of intraseptal anesthesia for pain-free dental treatment

    Directory of Open Access Journals (Sweden)

    G Gazal

    2016-01-01

    Full Text Available Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003, and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine, and intraosseous injection (2% lidocaine are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

  15. Role of intraseptal anesthesia for pain-free dental treatment.

    Science.gov (United States)

    Gazal, G; Fareed, W M; Zafar, M S

    2016-01-01

    Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia. PMID:26955316

  16. Anesthesia for cesarean section in pregnancies complicated by placenta previa

    International Nuclear Information System (INIS)

    Objective was to evaluate the factors affecting the choice of anesthetic technique for cesarean section in women with placenta previa. In this retrospective study, the records of the labor Ward Theatre of the University of Benin Teaching Hospital, Benin City, Nigeria were examined from January 2000 to December 2004 to identify all the women who had cesarean section for placenta previa. The patient's socio-demographic characteristics, type of placenta previa, anesthesia technique, estimated blood loss, maternal and fetal outcomes were recorded. One hundred and twenty-six patients had cesarean section for placenta previa, however, only 81 patients 64.3% were available for analysis. General anesthesia was administered to 52/81 patients 64.2% and 29/81 patients 35.8% received spinal anesthesia. A history of antepartum bleeding was recorded in 61.7% n=50. Of 31 patients without antepartum hemorrhage APH, 15/31 had general anesthesia and 16/31 had spinal anesthesia. The patients who had APH, 37/50 had general anesthesia and 1/50 had spinal anesthesia. There was an increased chance of using general anesthesia and if APH were present p=0.03, odds ratio=3.1, 95% confidence interval=1.2-7.7. Spinal anesthesia may useful in patients with placenta previa. The presence of APH may encourage the use of general anesthesia for cesarean delivery. (author)

  17. The comparison of anesthesia effect of lung surgery through video-assisted thoracic surgery: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Jing-Dong Ke

    2015-01-01

    Conclusion: These results indicated that epidural anesthesia can save operating time and postoperative hospital stay time. But epidural anesthesia and general anesthesia have the same effect on complications.

  18. General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy

    Directory of Open Access Journals (Sweden)

    Lucía Vizcaíno-Martínez

    2014-01-01

    Full Text Available Objective: The aim was to evaluate general anesthesia (GA plus ilioinguinal nerve block (IIB versus spinal anesthesia (SA in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced. Results: Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P < 0.001 and at discharge (P < 0.001 in favor of the GA plus ilioinguinal block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001, with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction. Conclusion: General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients.

  19. Acupuncture in ambulatory anesthesia: a review

    OpenAIRE

    Norheim AJ; Liodden I; Alræk T

    2015-01-01

    Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-an...

  20. A Computerized Record System for Anesthesia Services

    OpenAIRE

    Chase, Christopher R.; Merz, Barbara A.

    1982-01-01

    We have developed a computerized record system, the CAPE system, which supports patient management, administrative and research applications for anesthesia services in our hospital, the Medical Center Hospital of Vermont. In this paper we briefly describe the CAPE system and, as an example of its use in our hospital, we describe the development and implementation of a preoperative screening program used to identify patients at high risk to postoperative respiratory complications.

  1. Assessment of propofol anesthesia in the rabbit

    OpenAIRE

    Campos, Sónia Patrícia Seabra

    2010-01-01

    The growing interests in propofol as an intravenous anesthetic agent and in particular to its use in rabbits were the motivation for this work. The rabbit is the third most common pet, and is also used as a biomedical research model in a wide range of science branches such as pharmacology, toxicology, anesthesiology and surgery. The main goal of this study was to explore the effects of Total Intravenous Anesthesia (TIVA) with propofol in rabbits. Different infusion rates were administrated...

  2. Human factors research in anesthesia patient safety.

    OpenAIRE

    Weinger, M.B.; Slagle, J.

    2001-01-01

    Patient safety has become a major public concern. Human factors research in other high-risk fields has demonstrated how rigorous study of factors that affect job performance can lead to improved outcome and reduced errors after evidence-based redesign of tasks or systems. These techniques have increasingly been applied to the anesthesia work environment. This paper describes data obtained recently using task analysis and workload assessment during actual patient care and the use of cognitive ...

  3. [Chronic pain and regional anesthesia in children].

    Science.gov (United States)

    Dadure, C; Marec, P; Veyckemans, F; Beloeil, H

    2013-10-01

    Chronic pain is usually underestimated in children, due to lack of knowledge and its specific signs. In addition to suffering, chronic pain causes a physical, psychological, emotional, social, and financial burden for the child and his family. Practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of these techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents, but it often goes undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in phantom limb pain after limb amputation, but they remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of postdural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of the patient's blood, called a blood-patch. Finally, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and her problem in its entirety. PMID:23953871

  4. The National Anesthesia Clinical Outcomes Registry.

    Science.gov (United States)

    Liau, Adrian; Havidich, Jeana E; Onega, Tracy; Dutton, Richard P

    2015-12-01

    The Anesthesia Quality Institute (AQI) was chartered in 2008 by the American Society of Anesthesiologists to develop the National Anesthesia Clinical Outcomes Registry (NACOR). In this Technical Communication, we will describe how data enter NACOR, how they are authenticated, and how they are analyzed and reported. NACOR accepts case-level administrative, clinical, and quality capture data from voluntarily participating anesthesia practices and health care facilities in the United States. All data are transmitted to the AQI in summary electronic files generated by billing, quality capture, and electronic health care record software, typically on a monthly basis. All data elements are mapped to fields in the NACOR schema in accordance with a publicly available data dictionary. Incoming data are loaded into NACOR by AQI technologists and are subject to both manual and automated review to identify systematically missing elements, miscoding, and inadvertent corruption. Data are deidentified in compliance with Health Insurance Portability and Accountability Act regulations. The database server of AQI, which houses the NACOR database, is protected by 2 firewalls within the American Society of Anesthesiologists' network infrastructure; this system has not been breached. The NACOR Participant User File, a deidentified case-level dataset of information from NACOR, is available to researchers at participating institutions. NACOR architecture and the nature of the Participant User File include both strengths and weaknesses. PMID:26579661

  5. General versus epidural anesthesia for lumbar microdiscectomy.

    Science.gov (United States)

    Ulutas, Murat; Secer, Mehmet; Taskapilioglu, Ozgur; Karadas, Soner; Akyilmaz, Ahmet Aykut; Baydilek, Yunus; Kocamer, Betul; Ozboz, Ayse; Boyaci, Suat

    2015-08-01

    This study was a retrospective analysis of 850 lumbar microdiscectomy (LMD) under epidural anesthesia (EA; n=573) or general anesthesia (GA; n=277) performed by the same surgeon and paid by invoice to the Social Security Institution of the Turkish Republic between April 2003 and May 2013. Although GA is the most frequently used method of anesthesia during LMD, the choice of regional anesthetia (epidural, spinal or a combination of these) differs between surgeons and anesthetists. Studies have reported that EA in surgery for lumbar disc herniation may be more reliable than GA, as it enables the surgeon to communicate with the patient during surgery, but few studies have compared the costs of these two anesthetic methods in LMD. We found that EA patient costs were significantly lower than GA patient costs (p0.05). The anesthetic method used during LMD affected the complication rate, cost and efficiency of operating room use. We suggest that EA is an anesthetic method that can contribute to health care cost savings and enable LMD to be completed with less nerve root manipulation and more comfort, efficacy, reliability and cost efficiency without affecting the success rate of the surgical procedure. PMID:26067543

  6. Dental treatment of handicapped patients using endotracheal anesthesia.

    OpenAIRE

    Pohl, Y.; A. Filippi; GEIGER, G.; Kirschner, H; Boll, M.

    1996-01-01

    Dental treatment using endotracheal anesthesia is indicated where acute odontogenic infections, accidental injuries, or multiple caries and periodontitis marginalis require surgical and/or restorative treatment. It is also indicated where it is not possible to use psychological support during local anesthesia or during premedication or analgosedation. Dental treatment of handicapped patients using endotracheal anesthesia is described, along with indication and frequency of such treatment. The...

  7. 25 gauge vitrectomy under topical anesthesia: A pilot study

    OpenAIRE

    Raju Biju; Raju NSD; Raju Anju

    2006-01-01

    Aims: To evaluate the safety and efficacy of transconjunctival 25 gauge vitrectomy under topical anesthesia. Settings and Design: A pilot study of consecutive cases which underwent 25 gauge vitrectomy under topical anesthesia. Materials and Methods: Seven eyes of 7 patients underwent 25 gauge vitrectomy under topical anesthesia with a pledget soaked in anesthetic, for vitreous hemorrhage (2 eyes), retained cortex (1 eye) and postoperative endophthalmitis (4 eyes). Subjective pain and dis...

  8. Modeling the dynamical effects of anesthesia on brain circuits

    OpenAIRE

    Ching, ShiNung; Brown, Emery N

    2014-01-01

    General anesthesia is a neurophysiological state that consists of unconsciousness, amnesia, analgesia, and immobility along with maintenance of physiological stability. General anesthesia has been used in the United States for more than 167 years. Now, using systems neuroscience paradigms how anesthetics act in the brain and central nervous system to create the states of general anesthesia is being understood. Propofol is one of the most widely used and the most widely studied anesthetics. Wh...

  9. The application of sacral block anesthesia in pediatric interventional therapy

    International Nuclear Information System (INIS)

    Objective: To discuss the management and feasibility of sacral block anesthesia in pediatric interventional therapy. Methods: A total of 80 pediatric patients were randomly and equally divided into two groups. Patients in group A received sacral block anesthesia together with basic anesthesia with propofol, while patients in group B received intravenous anesthesia with propofol. Small amount of ketamine as maintaining dose was used in both groups when needed. Results: The interventional management was successfully completed in all patients. A marked decrease in blood pressure occurred in three patients of group A receiving sacral block anesthesia. In group B receiving intravenous anesthesia, a decrease of SpO2 to below 90 percent was seen in 8 cases, and obvious bradycardia developed in 12 cases. All these patients were treated with intravenous medication or by reducing the dose of propofol. Additional small dose of ketamine was needed in 4 patients during the procedure. Conclusion: Sacral block anesthesia combined with intravenous anesthesia is one of the effective anesthesia management schemes for pediatric interventional therapy. (authors)

  10. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  11. Effects of Isoflurane Anesthesia on Post-Anesthetic Sleep-Wake Architectures in Rats

    OpenAIRE

    Jang, Hwan-Soo; Jung, Ji-Young; Jang, Kwang-Ho; Lee, Maan-Gee

    2010-01-01

    The sleep homeostatic response significantly affects the state of anesthesia. In addition, sleep recovery may occur during anesthesia, either via a natural sleep-like process to occur or via a direct restorative effect. Little is known about the effects of isoflurane anesthesia on sleep homeostasis. We investigated whether 1) isoflurane anesthesia could provide a sleep-like process, and 2) the depth of anesthesia could differently affect the post-anesthesia sleep response. Nine rats were trea...

  12. Comparison of Total Intravenous Anesthesia (TIVA with Inhalation Anesthesia in Pediatric Bronchoscopy

    Directory of Open Access Journals (Sweden)

    Majid Razavi

    2013-12-01

    Full Text Available Background: Because of airway stimulations during the bronchoscopy and lack of direct access to the airway, preferred method of anesthesia for rigid bronchoscopy is already controversial. In this study we compared inhalation anesthesia with total intravenous anesthesia (TIVA for rigid bronchoscopy. Method and Materials: 30 patients aged 2-6 years were chosen divided on two same groups. Anesthesia in group I maintained with halothane and in group II maintained with remifentanil and propofol. Oxygenation, heart rate, respiratory rate, coughing, bucking, laryngospasm, bronchospasm were evaluated during and after surgery. Also Operation success and surgeon’s satisfaction were recorded as well.Results: Demographic findings were the same in both groups. Oxygenation and heart rate were more stable in group II (P=0.047 and P=0.026 respectively but there was no significant difference in respiratory rate between two groups (P=1. Success rate was also similar in both groups but surgeon’s satisfaction was significantly higher in TIVA (P=0.003. There was not any significant different between complications in two groups. Conclusion: We suggest TIVA for rigid bronchoscopy because of better oxygenation, more homodynamic stability, surgeon’s satisfaction, lack of air pollution and less interference with surgeon’s visual field.

  13. Anesthesia for tracheostomy for huge maxillofacial tumor

    Directory of Open Access Journals (Sweden)

    Abeer A Arab

    2014-01-01

    Full Text Available Providing sedation for patients with compromised upper airway is challenging. A 19-year-old female patient with huge maxillofacial tumor invading the whole pharynx scheduled for elective tracheostomy under local anesthesia due to compromised airway. The patient had gastrostomy tube for feeding. Venous cannulation was totally refused by the patient after repeated trials for exhausted sclerosed veins. Pre-operative mixture of dexmedetomidine with ketamine was administered through the gastrostomy tube with eutectic mixture of local anesthetics cream application over the planned tracheostomy site. The patient was sedated with eye opening to command. Local infiltration followed by tracheostomy was performed without patient complaints or recall of operative events.

  14. Updates of Topical and Local Anesthesia Agents.

    Science.gov (United States)

    Boyce, Ricardo A; Kirpalani, Tarun; Mohan, Naveen

    2016-04-01

    As described in this article, there are many advances in topical and local anesthesia. Topical and local anesthetics have played a great role in dentistry in alleviating the fears of patients, eliminating pain, and providing pain control. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. The modern-day dentist has the responsibility of knowing the variety of products on the market and should have at least references to access before, during, and after treatment. This practice ensures proper care with topical and local anesthetics for the masses of patients entering dental offices worldwide. PMID:27040295

  15. SURVEILLANCE OF BACTERIAL CONTAMINATION OF ANESTHESIA MACHINE AND PERIPHERAL INTRAVENOUS CANNULA DURING GENERAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Ch. Srinivas

    2015-01-01

    Full Text Available BACKGROUND: Given the expanding role of the anesthesiologist as the “total perioperative physician,” the increasing number of invasive procedures performed by anesthesiologists, and the increase in the prevalence of emerging diseases, stringent attention to infection control practices is paramount. AIM : To find out the bacterial contamination of anesthesia machine and internal lumen of the injection port of peri pheral intravenous cannula, and evaluation of its risk factors during general anesthesia procedures. MATERIALS AND METHODS: 50 general anaesthesia procedures were selected randomly after the approval of ethics committee and informed consent from the patien t. Samples were taken for bacterial culture on 2 sites in anesthesia machine (Adjustable pressure limiting valve {APL} and agent concentration dial of inhaled anesthetics{AD} and internal lumen of the injection port of peripheral intravenous cannula befor e starting and after completion of procedures. Bacteria and colony count were identified according to standard laboratory methods . RESULTS : Adjustable pressure limiting valve area was contaminated with bacteria in 12% (6/50 before starting procedure and 34% (17/50 after completion of procedures. Agent concentration dial of inhaled anesthetic site was contaminated with bacteria in 10% (5/50 before starting procedure and 28% (14/50 after completion of procedures. Bacterial contamination occurred in the i nternal lumen of the injection port of peripheral intravenous cannula in 16% (8/50 during general anesthesia. Isolated bacteria in anesthesia machine and peripheral intra venous cannula sites are STAPHYLO COCCI, STREPTOCOCCI, MICRO COCCI, ENTERO COCCI, E. COLI, and PSEUDOMONAS . CONCLUSION: Bacterial contamination is significantly associated with procedure order in a day (bacterial contamination rate is increased from first procedure to fifth procedure in a day. It is significantly associated with surgical s pecialty highest in

  16. Simulation of electroencephalographic signals for depth of anesthesia assessment

    Science.gov (United States)

    Panichev, Oleg; Popov, Anton; Bodilovskyi, Oleg; Tkachenko, Valerii

    2011-10-01

    The problem of simulating electroencephalographic (EEG) signals for different stages of anesthesia is considered. Review of existing techniques for EEG simulation is made and the new technique for simulating the EEG using only preliminary definition of magnitudes of harmonic components for every frequency ranges is presented. During experimental part EEG signals for four stages of ether anesthesia were simulated.

  17. Awareness during general anesthesia: new technology for an old problem.

    Science.gov (United States)

    Halliburton, J R

    1998-05-01

    The possibility of awareness during general anesthesia causes apprehension for the patient and the Certified Registered Nurse Anesthetist (CRNA). The goals of general anesthesia are to prevent the sensation of pain and produce a state of sedation, hypnosis, and unconsciousness so the patient will not remember the surgical procedure. An inadequate level of anesthesia can result in patient awareness during surgery. The current practice of anesthesia relies on indirect hemodynamic measurements such as blood pressure and heart rate to monitor the sedative hypnotic state of the patient's brain during general anesthesia. Hemodynamic responses are not reliable for predicting awareness just as blood pressure and heart rate are not indicative of consciousness. Electroencephalogram (EEG) waveforms are known to be affected by anesthetics. Characteristic EEG waveforms are a direct indication of the patient's level of consciousness. Unprocessed and computer-processed EEG recordings have been used in an attempt to monitor the patient's level of consciousness during general anesthesia. A raw or unprocessed EEG recording to monitor the level of consciousness during general anesthesia is problematic. The EEG signal is complex, affected by artifact, and it requires a dedicated interpreter. Conventional processed EEG monitoring systems are problematic because of the complexity of the equipment and technical difficulty of reading the EEG recording. The purpose of this article is to describe the history of awareness during anesthesia and introduce a new processed EEG monitor, the Bispectral Index (BIS) (Aspect Medical Systems, Inc., Natick, MA) with implications for future clinical use and research. PMID:9726194

  18. General anesthesia suppresses normal heart rate variability in humans

    Science.gov (United States)

    Matchett, Gerald; Wood, Philip

    2014-06-01

    The human heart normally exhibits robust beat-to-beat heart rate variability (HRV). The loss of this variability is associated with pathology, including disease states such as congestive heart failure (CHF). The effect of general anesthesia on intrinsic HRV is unknown. In this prospective, observational study we enrolled 100 human subjects having elective major surgical procedures under general anesthesia. We recorded continuous heart rate data via continuous electrocardiogram before, during, and after anesthesia, and we assessed HRV of the R-R intervals. We assessed HRV using several common metrics including Detrended Fluctuation Analysis (DFA), Multifractal Analysis, and Multiscale Entropy Analysis. Each of these analyses was done in each of the four clinical phases for each study subject over the course of 24 h: Before anesthesia, during anesthesia, early recovery, and late recovery. On average, we observed a loss of variability on the aforementioned metrics that appeared to correspond to the state of general anesthesia. Following the conclusion of anesthesia, most study subjects appeared to regain their normal HRV, although this did not occur immediately. The resumption of normal HRV was especially delayed on DFA. Qualitatively, the reduction in HRV under anesthesia appears similar to the reduction in HRV observed in CHF. These observations will need to be validated in future studies, and the broader clinical implications of these observations, if any, are unknown.

  19. The Effect of Neuraxial Anesthesia on Maternal Cerebral Hemodynamics

    NARCIS (Netherlands)

    Postma, Ineke R.; van Veen, Teelkien R.; Mears, Scott L.; Zeeman, Gerda G.; Haeri, Sina; Belfort, Michael A.

    2014-01-01

    Objective Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia. Study Des

  20. Laparoscopic cholecystectomy under epidural anesthesia: A feasibility study

    Directory of Open Access Journals (Sweden)

    Ranendra Hajong

    2014-01-01

    Full Text Available Background: Laparoscopic cholecystectomy (LC is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia. Aims: The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated. Materials and Methods: In all, 20 patients with the American Society of Anesthesiologist′s class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study. Results: The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia. Conclusions: The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.

  1. Improving Patient Safety in Anesthesia: A Success Story?

    International Nuclear Information System (INIS)

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety

  2. A rare complication of spinal anesthesia: Intracranial subdural hemorrhage

    Directory of Open Access Journals (Sweden)

    Cengiz Kaplan

    2015-02-01

    Full Text Available Spinal (subarachnoid anesthesia (SA is a widely used general-purpose anesthesia. Postdural Puncture Headaches (PDPHs represent one of the principal complications of spinal anesthesia. A 21-year-old man underwent inguinal herniorrhaphy and orchiectomy using spinal anesthesia. Postoperatively, our patient started to have a headache with nausea. The patient received symptomatic therapy, but the severe headache persisted even in the supine position, with his vital signs and neurological examination being normal. Cranial MRI showed a bilateral subdural hematoma from his frontal to temporal region. A postdural puncture headache is a frequent complication after spinal anesthesia. However, serious complications, such as an intracranial subdural hemorrhage, can rarely occur. [Arch Clin Exp Surg 2015; 4(1.000: 54-56

  3. General anesthesia for nuclear magnetic resonance imaging

    International Nuclear Information System (INIS)

    The core of the MAGNETOM diagnostic device is a liquid helium-cooled cryogenic magnet, having the shape of a hollow cylinder about 2 m long, 50 to 60 cm i.d. Its inner space is designed to accommodate a bench with the patient, whose part examined, usually the head, is enclosed in a smaller coil and is located roughly in the center of the magnet. The examination takes 4 to 20 minutes, during which the patient must be fixed to prevent any motion. Inhalation anesthesia with spontaneous ventilation using the Jackson-Rees or Bain's system and a laryngeal mask is considered the safest way where no special equipment is employed. If artificial ventilation is necessary, balanced anesthesia with either manual ventilation using Bain's system or a fluidic type ventilator seems to be the best choice. The preparation of the patient prior to the examination, the premedication, and the monitoring equipment are described. (J.B.). 1 tab., 5 figs., 11 refs

  4. Anesthesia considerations in the obese gravida.

    LENUS (Irish Health Repository)

    Tan, Terry

    2011-12-01

    Obesity is associated with serious morbidity during pregnancy, and obese women also are at a high risk of developing complications during labor, leading to an increased risk for instrumental and Cesarean deliveries. The engagement of the obstetrical anesthetist in the management of this group of high-risk patients should be performed antenatally so that an appropriate management strategy can be planned in advance to prevent an adverse outcome. Good communication between all care providers is essential. The obese patient in labor should be encouraged to have a functioning epidural catheter placed early in labor. Apart from providing analgesia and alleviating physiological derangements during labor, the presence of a functioning epidural catheter can also be used to induce anesthesia quickly in the event of an emergency cesarean section, thus avoiding a general anesthesia, which has exceedingly high risks in the obese parturient. Successful management of the obese patient necessitates a comprehensive strategy that encompasses a multidisciplinary and holistic approach from all care-providers.

  5. The history of the nurse anesthesia profession.

    Science.gov (United States)

    Ray, William T; Desai, Sukumar P

    2016-05-01

    Despite the fact that anesthesia was discovered in the United States, we believe that both physicians and nurses are largely unaware of many aspects of the development of the nurse anesthetist profession. A shortage of suitable anesthetists and the reluctance of physicians to provide anesthetics in the second half of the 19th century encouraged nurses to take on this role. We trace the origins of the nurse anesthetist profession and provide biographical information about its pioneers, including Catherine Lawrence, Sister Mary Bernard Sheridan, Alice Magaw, Agatha Cobourg Hodgins, and Helen Lamb. We comment on the role of the nuns and the effect of the support and encouragement of senior surgeons on the development of the specialty. We note the major effect of World Wars I and II on the training and recruitment of nurse anesthetists. We provide information on difficulties faced by nurse anesthetists and how these were overcome. Next, we examine how members of the profession organized, developed training programs, and formalized credentialing and licensing procedures. We conclude by examining the current state of nurse anesthesia practice in the United States. PMID:27041264

  6. Simulation in teaching regional anesthesia: current perspectives

    Directory of Open Access Journals (Sweden)

    Udani AD

    2015-08-01

    Full Text Available Ankeet D Udani,1 T Edward Kim,2,3 Steven K Howard,2,3 Edward R Mariano2,3On behalf of the ADAPT (Anesthesiology-Directed Advanced Procedural Training Research Group1Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; 3Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USAAbstract: The emerging subspecialty of regional anesthesiology and acute pain medicine represents an opportunity to evaluate critically the current methods of teaching regional anesthesia techniques and the practice of acute pain medicine. To date, there have been a wide variety of simulation applications in this field, and efficacy has largely been assumed. However, a thorough review of the literature reveals that effective teaching strategies, including simulation, in regional anesthesiology and acute pain medicine are not established completely yet. Future research should be directed toward comparative-effectiveness of simulation versus other accepted teaching methods, exploring the combination of procedural training with realistic clinical scenarios, and the application of simulation-based teaching curricula to a wider range of learner, from the student to the practicing physician.Keywords: regional anesthesia, simulation, medical education, ultrasound, nerve block, simulator

  7. Anesthesia for subglottic stenosis in pediatrics

    Directory of Open Access Journals (Sweden)

    Eid Essam

    2009-01-01

    Full Text Available Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea. These include nasal causes such as choanal atresia or nasal stenosis; pharyngeal causes including lingual thyroid; laryngeal causes such as laryngomalacia; tracheobronchial causes such as tracheal stenosis; and subglottic stenosis. Lesions in the oropharynx may cause stertor, while lesions in the laryngotracheal tree will cause stridor. Subglottic stenosis is the third leading cause of congenital stridors in the neonate. Subglottic Stenosis presents challenges to the anesthesiologist. Therefore, It is imperative to perform a detailed history, physical examination, and characterization of the extent and severity of stenosis. Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction. Choice of operation is dependent on the surgeon′s comfort, postoperative capabilities, and severity of disease. For high-grade stenosis, single-stage laryngotracheal resection or cricotracheal resection are the best options. It has to be borne in mind that the goal of surgery is to allow for an adequate airway for normal activity without the need for tracheostomy. Anesthesia for airway surgery could be conducted safely with either sevofl uraneor propofol-based total intravenous anesthesia.

  8. Anesthesia during and Immediately after Spaceflight

    Science.gov (United States)

    Seubert, Christoph N.; Price, Catherine; Janelle, Gregory M.

    2006-01-01

    The increasing presence of humans in space and long-duration manned missions to the Moon or Mars pose novel challenges to the delivery of medical care. Even now, cumulative person-days in space exceed 80 years and preparations for a return to the Moon are actively underway. Medical care after an emergent de-orbit or an accident during a non-nominal landing must not only address the specific disease or injuries but also the challenges posed by physiologic adaptations to microgravity. In the highly autonomous situation of a long-term space mission the situation is even more complex, because personnel, equipment, specific training, and clinical experience are by definition limited. To summarize our current knowledge specifically for anesthetic care during and immediately after spaceflight, we will review physiologic adaptations to microgravity with particular emphasis on the resulting anesthetic risks, discuss veterinary experiences with anesthesia in weightlessness or in animals adapted to microgravity, describe current research that pertains to anesthesia and spaceflight and point out unresolved questions for future investigation.

  9. Isoflurane anesthesia is a valuable alternative for alpha-chloralose anesthesia in the forepaw stimulation model in rats.

    NARCIS (Netherlands)

    Sommers, M.G.J.; Egmond, J. van; Booij, L.H.D.J.; Heerschap, A.

    2009-01-01

    Isoflurane (ISO) can be a valuable alternative for alpha-chloralose (ACL) anesthesia in functional MRI (fMRI) studies. Therefore, we compared the efficacy of the blood oxygen level dependent (BOLD) effect in fMRI studies during ISO and ACL anesthesia sequentially in the same animals. After non-invas

  10. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

    Full Text Available Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-analyses and reviews of acupuncture and related techniques for postoperative nausea and vomiting (POVN and postoperative vomiting (POV show promising results while many clinicians remain skeptical of the value of acupuncture. Given the interest in finding safe non-pharmacological approaches toward postoperative care, this body of knowledge needs to be considered. This review critically appraises and summarizes the research on acupuncture and acupressure in ambulatory anesthesia during the last 15 years.Methods: Articles were identified through searches of Medline, PubMed, and Embase using the search terms “acupuncture” or “acupuncture therapy” in combination with “ambulatory anesthesia” or “ambulatory surgery” or “day surgery” or “postoperative”. A corresponding search was done using “acupressure” and “wristbands”. The searches generated a total of 104, 118, and 122 references, respectively.Results: Sixteen studies were included; eight studies reported on acupuncture and eight on acupressure. Nine studies found acupuncture or acupressure effective on primary endpoints including postoperative nausea and vomiting, postoperative pain, sore throat, and emergence agitation. Four studies found acupuncture had a similar effect to antiemetic medication.Conclusion: Overall, the studies were of fairly good quality. A large proportion of the reviewed papers highlights an effect of acupuncture or acupressure on postoperative morbidities in an ambulatory setting

  11. COMPARATIVE STUDY OF SPINAL ANESTHESIA AND GENERAL ANESTHESIA IN CHILDREN UNDERGOING SURGERIES BELOW UMBILICUS

    Directory of Open Access Journals (Sweden)

    Ashish

    2014-09-01

    Full Text Available AIM: Aim of our study to compare the spinal anaesthesia and general anaesthesia in children undergoing surgeries below umbilicus. OBJECTIVE: to assess the patient comfort in pt. with GA and pt. with spinal anaesthesia, the adequate surgical condition, assess the hemodynamic change, assess the post op analgesia and to assess the post op complication. MATERIAL AND METHOD: 60 ASA grade I & II children of either sex, aged 5-12 yrs undergoing elective surgeries for the lower abdominal, perineal and lower limb surgeries were taken. After taking a detailed history, thorough general physical examination, all pertinent investigation were carried out to exclude any systemic disease. Patients were classified randomly into 2 groups (30 patients in each group. Group A: General anesthesia was given. Group P: subarachnoid block was given. Intraoperative monitoring consisted of SPO2, PR, NIBP, RR and assessment of duration of post-operative analgesia. P-value <0.05 consider significant. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery In SAB since less general anaesthetic drug including parental opioid are used the risk and postoperative respiratory depression is minimal. The stress response to surgery is also limited and recovery is fast. Postoperatively complications like sore throat, laryngeal irritation, cough etc. was also less associated with it. CONCLUSION pediatric spinal anesthesia is not only a safe alternative to general anesthesia but often the anesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and flexibility is broken and is now found to be even more cost effective. It is much preferred technique special for common day case surgeries generally performed in the pediatric age group.

  12. Tissue microcirculation measured by vascular occlusion test during anesthesia induction.

    Science.gov (United States)

    Kim, Tae Kyong; Cho, Youn Joung; Min, Jeong Jin; Murkin, John M; Bahk, Jae-Hyon; Hong, Deok Man; Jeon, Yunseok

    2016-02-01

    Tissue microcirculation measured by vascular occlusion test is impaired during septic shock. However, it has not been investigated extensively during anesthesia induction. The aim of the study is to evaluate tissue microcirculation during anesthesia induction. We hypothesized that during anesthesia induction, tissue microcirculation measured by vascular occlusion test might be enhanced with peripheral vasodilation during anesthesia induction. We conducted a prospective observational study of 50 adult patients undergoing cardiac surgery. During anesthesia induction, we measured and analyzed tissue oxygen saturation, vascular occlusion test, cerebral oximetry, forearm-minus-fingertip skin temperature gradients and hemodynamic data in order to evaluate microcirculation as related to alterations in peripheral vasodilation as reflected by increased Tforearm-finger thermal gradients. During anesthesia induction, recovery slope during vascular occlusion test and cerebral oxygen saturation increased from 4.0 (1.5) to 4.7 (1.3) % s(-1) (p = 0.02) and 64.0 (10.2) to 74.2 (9.2) % (p Forearm-minus-fingertip skin temperature gradients decreased from 1.9 (2.9) to -1.4 (2.2) °C (p blood pressure and forearm-minus-fingertip skin temperature gradients decrease while cerebral oximetry and vascular occlusion test recovery slope increase. These findings suggest that anesthesia induction increases tissue microcirculation with peripheral vasodilation. PMID:25750016

  13. [Rocuronium anesthesia induced anaphylactic shock: a case report].

    Science.gov (United States)

    Qiu, Min; Zong, Ya-nan; Lu, Jian; Ma, Lu-lin; Zheng, Qing; Guo, Xiang-yang

    2015-10-18

    Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen, and it could be an unpredictable and life-threatening cause during anesthesia. The main purpose of this paper is to report a case of anaphylactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period. A 63-year-old man, with a mass on his adrenal, was scheduled to a laparoscopic adrenal tumor excision. During the anesthesia induction period, after administrated sulfentanil, propofol and rocuronium, the blood pressure was decreased and the heart rate was increased. Then, the patient had rash on his whole body and developed an anaphylactic shock. After being treated with the anti-allergic agents and norepinephrine, the rash disappeared and the vital sign become stable. The patient felt nothing uncomfortable during the two weeks'follow-up. Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period. The most common inducements are muscle relaxant, latex and antibiotics. Anaphylactic reactions in the perioperative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Before anesthesia, we should acquire the allergic history. During the anesthesia period, the vital sign and the skin should be observed carefully. PMID:26474637

  14. General Anesthesia for a Patient With Pelizaeus-Merzbacher Disease.

    Science.gov (United States)

    Kamekura, Nobuhito; Nitta, Yukie; Takuma, Shigeru; Fujisawa, Toshiaki

    2016-01-01

    We report the successful management of general anesthesia for a patient with Pelizaeus-Merzbacher disease (PMD). PMD is one of a group of progressive, degenerative disorders of the cerebral white matter. The typical clinical manifestations of PMD include psychomotor retardation, nystagmus, abnormal muscle tone, seizures, and cognitive impairment. General anesthesia for a patient with PMD may be difficult mainly because of seizures and airway complications related to poor pharyngeal muscle control. In addition, the possibility of exacerbation of spasticity should be considered. A 20-year-old man with PMD required removal of impacted wisdom teeth under general anesthesia. General anesthesia was induced with thiamylal, fentanyl, and desflurane. Anesthesia was maintained with desflurane and continuous intravenous remifentanil under bispectral index and train-of-4 monitoring. Anesthesia lasted 1 hour 20 minutes and was completed uneventfully. Airway complications, seizures, and exacerbation of spasticity did not occur postoperatively. Preoperatively, our patient had no history of epilepsy attacks or aspiration pneumonia, and no clinical symptoms of gastroesophageal reflux disease. Therefore, exacerbation of spasticity was one of the most likely potential complications. Identification of these associated conditions and evaluation of risk factors during preoperative examination is important for performing safe anesthesia in these patients. PMID:27269667

  15. Total spinal anesthesia in an achondroplasic patient: case report

    Directory of Open Access Journals (Sweden)

    Amiri H R

    2008-06-01

    Full Text Available Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

  16. The effect of hypernatremic state on anesthesia: male Wistar rat

    Directory of Open Access Journals (Sweden)

    Heydarpour F, Rostami A, Alipour M, Amini B, Heydarpour P

    2008-07-01

    Full Text Available "nBackground: The function of internal systems can be influenced significantly by hypernatremia, even anesthesia may be affected by this electrolyte imbalance. The aim of this study was to determine the effects of a single anesthetic dose of ketamine in an experimental rat model of chronic hypernatremia. "n"nMethods: Sixty male Wistar rats, weighing 300(±20g, were allocated randomly to three groups: the control group received drinking water and test groups 1 and 2 received 1% and 2% NaCl, respectively, for 144 hours. We measured the parameters of sensitivity to the ketamine injection (125mg/kg including length of times to the inhibition of the righting reflex, inhibition of the response to painful stimulus and the times to the reappearance of the response to painful stimulus and recovery from anesthesia. We also determined the mortality rates during anesthesia. "n"nResults: The times for inhibition of the righting reflex and response to painful stimulus for group 2 were significantly shorter than those for group 1 and the control group. The times for the reappearance of response to painful stimulus and full recovery from anesthesia in group 2 were significantly longer than those of group 1 and the control group. "n"nConclusions: Hypernatremia affects ketamine anesthesia in the rat, increasing the speed of passing through the different steps of anesthesia. The duration of ketamine efficacy increases, while recovery from anesthesia is significantly delayed.

  17. Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia

    Directory of Open Access Journals (Sweden)

    LaQuia A. Vinson

    2016-08-01

    Full Text Available The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA or office-based general anesthesia (OBGA in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12- and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6- and 12-month recall visits p = 0.038 & p = 0.029. Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.

  18. 42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia services...

  19. 42 CFR 414.46 - Additional rules for payment of anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Additional rules for payment of anesthesia services... Physicians and Other Practitioners § 414.46 Additional rules for payment of anesthesia services. (a... each anesthesia code that reflects all activities other than anesthesia time. These activities...

  20. Lack of effect of spinal anesthesia on drug metabolism

    International Nuclear Information System (INIS)

    The effect of spinal anesthesia on drug disposition was determined in six dogs with chronically implanted vascular catheters using propranolol as a model compound. On the first study day, 40 mg of unlabeled propranolol and 200 microCi of [3H]propranolol were injected into the portal and femoral veins respectively. Arterial blood samples were taken for 4 hr for measurement of plasma concentrations of labeled and unlabeled propranolol by high-pressure liquid chromatography (HPLC) and of [3H]propranolol by liquid scintillation counting of the HPLC eluant corresponding to each propranolol peak. Twenty-four hr later, spinal anesthesia was induced with tetracaine (mean dose 20.7 +/- 0.6 mg) with low sacral to midthoracic levels and the propranolol infusions and sampling were then repeated. Spinal anesthesia had no significant effect on either the intrinsic clearance of propranolol (2.01 +/- 0.75 L/min before and 1.9 +/- 0.7 L/min during spinal anesthesia), or on mean hepatic plasma flow (2.01 +/- 0.5 L/min before and 1.93 +/- 0.5 L/min during spinal anesthesia). The systemic clearance and elimination half-life of propranolol were also unchanged by spinal anesthesia (0.9 +/- 0.23 L/min on the first day, 0.7 +/- 0.1 L/min during spinal anesthesia; and 101 +/- 21 min on the first day, 115 +/- 16 min during spinal anesthesia, respectively). The volume of distribution (Vd) of propranolol was similarly unaffected by spinal anesthesia

  1. Propofol alternatives in gastrointestinal endoscopy anesthesia

    Directory of Open Access Journals (Sweden)

    Basavana Gouda Goudra

    2014-01-01

    Full Text Available Although propofol has been the backbone for sedation in gastrointestinal endoscopy, both anesthesiologists and endoscopists are faced with situations where an alternative is needed. Recent national shortages forced many physicians to explore these options. A midazolam and fentanyl combination is the mainstay in this area. However, there are other options. The aim of this review is to explore these options. The future would be, invariably, to move away from propofol. The reason is not in any way related to the drawbacks of propofol as a sedative. The mandate that requires an anesthesia provider to administer propofol has been a setback in many countries. New sedative drugs like Remimazolam might fill this void in the future. In the meantime, it is important to keep an open eye to the existing alternatives.

  2. TONSILLECTOMY UNDER LOCAL ANESTHESIA IN MALI

    Directory of Open Access Journals (Sweden)

    SACKO HB

    2015-04-01

    Full Text Available BACKGROUND The objective of this study was to analyze a series of tonsillectomies performed in the ENT Reference CentreoftheHealth, DistrictIVBAMAKOMALI PATIENTS and METHODS The study was conducted between June 2003 and May 2013 focused on 166 patients. Patients with chronic tonsillitis, obstructive hypertrophy of the Palatine tonsils, caseous tonsillitis were included in the study. The method of dissection of the tonsils in sitting position (home position was the technique used. RESULTS A predominance of female 114 (68.70% were observed. The average age of the patients was 25 years with extremes from 12 to 54 years. Tonsillectomy was bilateral in all patients of the study. The main indications were: chronic tonsillitis 101 (60.84%. There was no major complication during the postoperative period. CONCLUSION Tonsillectomy under local anesthesia is well tolerated by patients in a tropical environment. Its cost is less.

  3. AAHA anesthesia guidelines for dogs and cats.

    Science.gov (United States)

    Bednarski, Richard; Grimm, Kurt; Harvey, Ralph; Lukasik, Victoria M; Penn, W Sean; Sargent, Brett; Spelts, Kim

    2011-01-01

    Safe and effective anesthesia of dogs and cats rely on preanesthetic patient assessment and preparation. Patients should be premedicated with drugs that provide sedation and analgesia prior to anesthetic induction with drugs that allow endotracheal intubation. Maintenance is typically with a volatile anesthetic such as isoflurane or sevoflurane delivered via an endotracheal tube. In addition, local anesthetic nerve blocks; epidural administration of opioids; and constant rate infusions of lidocaine, ketamine, and opioids are useful to enhance analgesia. Cardiovascular, respiratory, and central nervous system functions are continuously monitored so that anesthetic depth can be modified as needed. Emergency drugs and equipment, as well as an action plan for their use, should be available throughout the perianesthetic period. Additionally, intravenous access and crystalloid or colloids are administered to maintain circulating blood volume. Someone trained in the detection of recovery abnormalities should monitor patients throughout recovery. Postoperatively attention is given to body temperature, level of sedation, and appropriate analgesia. PMID:22058343

  4. Effect of Tramadol on Medetomidine and Ketamine Anesthesia in Dogs

    OpenAIRE

    W. Choi, H. S. Jang, S. H. Yun, J. S. Park, Y. S. Kwon and K. H. Jang*

    2011-01-01

    The analgesic effects of three different doses of tramadol as a preanesthetic in medetomidine-ketamine anesthesia in dogs were compared. Twenty-eight healthy adult mongrel dogs were used. The dogs were divided into four groups at random; 1 ml kg-1 of normal saline, 1, 2 or 4mg kg-1 of tramadol premedication (group Control, TRA1, TRA2 and TRA4) was then administered intravenously followed by medetomidine and ketamine anesthesia. The behavioral changes, the duration of surgical anesthesia, bloo...

  5. Effects of leucovorin and methylcobalamin with N2O anesthesia

    International Nuclear Information System (INIS)

    Results of the deoxyuridine suppression test, a good marker for defining biochemical megaloblastosis caused by deficiency of folate and vitamin B12, became abnormal (> 10%) after 6 hours of administration of nitrous oxide anesthesia. 5-Formyltetrahydrofolate and methylcobalamin administration during nitrous oxide anesthesia have no remarkable effect on the correction of deoxyuridine suppression test values. On the other hand, 5-formyltetrahydrofolate and methylcobalamin administrated at the end of nitrous oxide anesthesia corrected the abnormal deoxyuridine suppression test values nearly to normal range within 1 hour. 19 references, 4 figures, 3 tables

  6. Effect of Epidural Block under General Anesthesia on Pulse Transit Time

    International Nuclear Information System (INIS)

    Epidural block under general anesthesia has been widely used to control postoperative pain. In this anesthetic state many hemodynamic parameters are changed. Moreover pulse transit time is influenced by this memodynamic change. PPT change in the finger and the toe due to relaxation of arterial wall muscle after general anesthesia and epidural block under general anesthesia. This study, in the both general anesthesia and epidural block under general anesthesia, ΔPTT of the toe and of the finger are measured. In addition, ΔPTT(toe-finger) of the epidural block under general anesthesia and of the general anesthesia were compared

  7. Effect of Epidural Block under General Anesthesia on Pulse Transit Time

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Byeong Cheol [Choonhae College of Health Sciences, Ulsan (Korea, Republic of); Kim, Seong Min [Konkuk University, Seoul (Korea, Republic of); Jung, Dong Keun; Kim, Gi Ryon [Dong-A University, Busan (Korea, Republic of); Lee, He Jeong; Jeon, Gye Rock [Pusan National University, Busan (Korea, Republic of)

    2005-08-15

    Epidural block under general anesthesia has been widely used to control postoperative pain. In this anesthetic state many hemodynamic parameters are changed. Moreover pulse transit time is influenced by this memodynamic change. PPT change in the finger and the toe due to relaxation of arterial wall muscle after general anesthesia and epidural block under general anesthesia. This study, in the both general anesthesia and epidural block under general anesthesia, {Delta}PTT of the toe and of the finger are measured. In addition, {Delta}PTT(toe-finger) of the epidural block under general anesthesia and of the general anesthesia were compared

  8. The comparison of Alfentanil and Remifentanil infusion during anesthesia on post-anesthesia recovery

    Directory of Open Access Journals (Sweden)

    Masood Entezariasl

    2012-01-01

    Full Text Available Background and Objective: With consideration the daily increased development of outpatient surgeries and high rate of these surgeries in elderly patients, rapid and safe recovery of patients is necessary. In this clinical trial study, recovery time and nausea and vomiting after the use of two rapid-onset narcotics, Alfentanil and Remifentanil, in elderly patients were evaluated. Methods: In this double-blind prospective clinical trial, 40 elderly patients (age above 65 years candidate to cataract surgery with general anesthesia were studied. The patients were divided randomly into two groups and for first group, 10 μg/kg of Alfentanil was injected and for second group Remifentanil 0.5 μg/kg was injected intravenously during 30 seconds one minute before induction. Both two groups were under general anesthesia with same method and during the anesthesia, first group took infusion of Alfentanil 1 μg/kg/min and second group took Remifentanil 0.1 μg/kg/min. In the end of surgery, the time intervals between end of anesthesia drug administration and spontaneous respiration, eyes opening with stimulation, verbal response and discharge of recovery room, also the incidence of complications related to narcotic drugs, especially nausea and vomiting, was recorded. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test and chi square test. Results: The time of spontaneous respiration in Alfentanil group was 2 minutes and in Remifentanil group was 3.3 minutes, the difference was not statistically significant (P=0.08. The time of eyes opening with stimulation, verbal response, and discharge of recovery room were not significantly different. During recovery, incidence of nausea and vomiting in Remifentanil group (30% of patients was significantly more than Alfentanil group (5% of patients (P=0.045. Conclusions: Recovery time between Alfentanil and Remifentanil group was not significantly different, but incidence of

  9. Obesity Is Independently Associated with Spinal Anesthesia Outcomes: A Prospective Observational Study

    OpenAIRE

    Kim, Hyo-Jin; Kim, Won Ho; Lim, Hyung Woo; Kim, Jie Ae; Kim, Duk-Kyung; Shin, Byung Seop; Sim, Woo Seog; Hahm, Tae Soo; Kim, Chung Su; Lee, Sangmin M.

    2015-01-01

    The influence of body-mass index (BMI) on spinal anesthesia is still controversial, with discrepant results reported in previous studies. To compare spinal anesthesia in obese and non-obese subjects, the anesthesia profiles in patients who underwent spinal anesthesia using intrathecal hyperbaric bupivacaine were compared. A total of 209 patients undergoing elective total knee replacement arthroplasty (TKRA) surgery under spinal anesthesia were divided into an NO (non-obese) group (BMI < 30 kg...

  10. Methodology for studies of natural circulation in closed circuits

    International Nuclear Information System (INIS)

    This work presents the results obtained from the analysis of stability of the phenomenon of the natural circulation for one-dimension single-phase flow in a closed loop, by a computer program with the method of finite element. The Navier-Stokes equations in cartesian geometry were used for the balance of mass, momentum and one equation for energy. The formulation has been implemented in a computer code developed at the Nuclear Engineering Institute(IEN-CNEN-RJ) and is now available either for futures analysis or design of nuclear systems. (author)

  11. Modeling of Nonlinear Marine Cooling Systems with Closed Circuit Flow

    DEFF Research Database (Denmark)

    Hansen, Michael; Stoustrup, Jakob; Bendtsen, Jan Dimon

    2011-01-01

    We consider the problem of constructing a mathematical model for a specific type of marine cooling system. The system in question is used for cooling the main engine and main engine auxiliary components, such as diesel generators, turbo chargers and main engine air coolers for certain classes of ...

  12. Use of closed circuit tv systems at the IEM cell

    International Nuclear Information System (INIS)

    The Interim Examination and Maintenance (IEM) Cell is a vertical, argon inerted hot cell located within the containment building of the Fast Flux Test Facility (FFTF). The IEM Cell has two basic functions: (1) to perform disassembly and non-destructive testing on radioactive, sodium-wetted reactor components, and (2) to provide a shielded work volume where radioactive, sodium-wetted reactor and refueling equipment can be repaired and maintained. Another important aspect of the cell is the ability to remotely remove, transfer and reinstall in-cell equipment for maintenance. This paper describes one technique used to enhance in-cell visibility during these remote operations

  13. Use of closed circuit TV systems at the IEM cell

    International Nuclear Information System (INIS)

    The Interim Examination and Maintenance (IEM) Cell is a vertical, argon inerted hot cell located within the containment building of the Fast Flux Test Facility (FFTF). The IEM Cell has two basic functions: (1) to perform disassembly and nondestructive testing on radioactive, sodium-wetted reactor components, and (2) to provide a shielded work volume where radioactive, sodium-wetted reactor and refueling equipment can be repaired and maintained. Another important aspect of the cell is the ability to remotely remove, transfer and reinstall in-cell equipment for maintenance. This paper describes one technique used to enhance in-cell visibility during these remote operations

  14. Mass-spectrometric monitoring of the stress reaction during anesthesia

    Science.gov (United States)

    Elizarov, A. Yu.; Levshankov, A. I.; Faizov, I. I.; Shchegolev, A. V.

    2013-10-01

    Clinical testing data for a mass-spectrometric method of estimating the patient's stress reaction to an injury done during anesthesia are presented. The essence of the method is monitoring the respiratory coefficient, which is defined as ratio N of the expiratory mass concentration of CO2 to the inspiratory mass concentration of O2 at each breathing cycle. For on-line monitoring of N, an electron ionization mass spectrometer connected to the breathing circuit of an inhalational anesthesia machine is used. Estimates of the anesthesia adequacy obtained with this method are compared with those obtained with the method that analyzes induced acoustic encephalographic potentials. It is shown that the method suggested is more sensitive to the level of the patient's stress reaction during anesthesia than the induced potential method.

  15. Nursing intervention in gynecologic brachytherapy under general anesthesia

    International Nuclear Information System (INIS)

    We reconsidered our nursing intervention in gynecologic intracavitary brachytherapy as general anesthesia was introduced. We recognized that safety, comfort, privacy protection and relief of anxiety of the patients were important points for nursing with corporation of other medical staffs. (author)

  16. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer;

    2004-01-01

    BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase when...... hypotension is present, which may have implications for the choice of treatment of hypotension. However, no long-term information or measurements of plasma volumes with or without hypotension after epidural anesthesia are available. METHODS: In 12 healthy volunteers, the authors assessed plasma (125I...... volunteers receiving hydroxyethyl starch. RESULTS: Plasma volume did not change per se after thoracic epidural anesthesia despite a decrease in blood pressure. Plasma volume increased with fluid administration but remained unchanged with vasopressors despite that both treatments had similar hemodynamic...

  17. [Demand for cleanliness of anesthesia machines and apparatus].

    Science.gov (United States)

    Kasuda, Haruyuki; Ozawa, Yoshiko; Miyake, Satoshi; Ohkubo, Takashi

    2010-05-01

    (1) Outer surface of anesthesia machines and patient monitors, and breathing bags are exposed to the contaminated anesthetists' hands and fingers. Disinfection by wiping surface of anesthesia machines with alcohol, and disinfecting hands and fingers with rubbing-type, alcohol-based antiseptics are encouraged. (2) Anesthesia equipments' breathing circuit part is contaminated by patients' breath and respiratory secretions. It is necessary to set rules for exchange of breathing circuit tubes and breathing bags, periodical cleansing and disinfection of canisters as well as inhalation and exhalation valves, and usage of bacteria filters. (3) Anesthesia apparatus (laryngoscope, tracheal tube and suction tube) contact with patients' oral cavity and airway, and thus they are categorized as semi-critical items that require high-level disinfection. PMID:20486566

  18. PNEUMOTHORAX AFTER MODIFIED RADICAL MASTECTOMY UNDER GENERAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Amminikutty

    2014-11-01

    Full Text Available A 67 yrs old lady who underwent modified Radical mastectomy under General Anesthesia developed pneumothorax in the immediate post-operative period. She was treated with chest tube insertion and was discharged from hospital 8 days later

  19. Do Patients Fear Undergoing General Anesthesia for Oral Surgery?

    OpenAIRE

    Elmore, Jasmine R.; Priest, James H.; Laskin, Daniel M.

    2014-01-01

    Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.

  20. Administration of Anesthesia in a Patient with Allgrove Syndrome

    Directory of Open Access Journals (Sweden)

    Ayse B. Ozer

    2012-01-01

    Full Text Available The aim of the present paper is to report the anesthesia administration to a patient who was planned to undergo Heller myotomy for achalasia. There wasnot property in the patient whom allgrove syndrome was excepted any steroid treatment in preoperative period. The night before the operation 18 mg of prednisolone was administered intravenously. Induction of anesthesia was performed with thiopental sodium, vecuronium and fentanyl and the patient received endotracheal intubation. Eyes were taped closed and protected with ointment during surgery. Maintenance of anesthesia was achieved with 2% sevoflurane concentration in 50% O2-50% N2O. 25 mg of prednisolone was infused preoperatively, and intervention with insulin treatment was initiated when blood glucose level rose to 18 mmol/L at 2 hours. Safe anesthesia can be achieved by observing the preoperative development of tracheal aspiration, adrenal insufficiency and, autonomic dysfunction carefully and maintaining eye protection.

  1. Linking sleep and general anesthesia mechanisms: this is no walkover.

    Science.gov (United States)

    Bonhomme, V; Boveroux, P; Vanhaudenhuyse, A; Hans, P; Brichant, J F; Jaquet, O; Boly, M; Laureys, S

    2011-01-01

    This review aims at defining the link between physiological sleep and general anesthesia. Despite common behavioral and electrophysiological characteristics between both states, current literature suggests that the transition process between waking and sleep or anesthesia-induced alteration of consciousness is not driven by the same sequence of events. On the one hand, sleep originates in sub-cortical structures with subsequent repercussions on thalamo-cortical interactions and cortical activity. On the other hand, anesthesia seems to primarily affect the cortex with subsequent repercussions on the activity of sub-cortical networks. This discrepancy has yet to be confirmed by further functional brain imaging and electrophysiological experiments. The relationship between the observed functional modifications of brain activity during anesthesia and the known biochemical targets of hypnotic anesthetic agents also remains to be determined. PMID:22145259

  2. [Development of an anesthesia ledger using relational database].

    Science.gov (United States)

    Hayashi, I; Mizoguchi, H; Fujiwara, M; Kato, H; Kawamura, J; Odashiro, M

    1993-08-01

    An anesthesia ledger was developed using relational database KIRI Ver3. This anesthesia database includes 33 items for input, for example patient's name, patient's I.D. number, data of operation, diagnosis, operative procedure, name of surgeon, name of anesthesiologists and so on. One can select data from displayed menu cards only by rolling down or rolling up the cursor at 19 items and can input numbers by keyboard at twelve items. Even a computer beginner can easily operate it after a minimal training. Only patient's name must be input by text style. We can construct this anesthesia database only by use of functions of KIRI Ver3 without programming. One can use this anesthesia ledger at any operative facilities by changing a part of database and a file of doctor's name. PMID:8366569

  3. 42 CFR 482.52 - Condition of participation: Anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... qualified doctor of medicine or osteopathy. The service is responsible for all anesthesia administered in... anesthesiologist; (2) A doctor of medicine or osteopathy (other than an anesthesiologist); (3) A dentist,...

  4. Monitoring of propofol and its metabolite during total intravenous anesthesia

    Science.gov (United States)

    Elizarov, A. Yu.; Ershov, T. D.; Levshankov, A. I.

    2011-12-01

    Intravenous hypnotic propofol and its metabolite are detected in real time during total intravenous anesthesia by an electron ionization mass spectrometer. The mass spectrometer is connected directly to the breathing circuit of an apparatus for inhalational anesthesia. Ratios between the propofol concentrations in expired air and blood serum are measured. It is concluded that real-time noninvasive monitoring of the propofol concentration in blood using electron ionization mass spectrometry is feasible.

  5. Mass spectrometer for real-time metabolism monitoring during anesthesia

    Science.gov (United States)

    Elizarov, A. Yu.; Levshankov, A. I.

    2012-06-01

    Mass-spectrometric monitoring of metabolism (CO2/O2) in the inspiration-expiration regime is used to estimate the anesthetic protection of the patient against surgical stimulation during combined anesthesia. A correlation between the anesthetic protection of the patient and the metabolic rate is demonstrated, and the periodic variation of the metabolic rate with time is found. The sevoflurane metabolism products and intravenous analgesic fentanyl are found in the blowing air of the patient during anesthesia.

  6. Cholecystectomy with local anesthesia as a resource in the elderly

    International Nuclear Information System (INIS)

    In the case of a patient presenting with acute cholescystectomy ideally is to remove the gallbladder. Sometimes there are special situations in malnourished elderlies with deterioration of its general status in whom a lengthy anesthesia intervention, even using not much invasive means as the videosurgery, put at risk the life of patient. In such cases the cholescystectomy with local anesthesia is an alternative that must to be taken into account. (author)

  7. Repetitive Pediatric Anesthesia in a Non-Hospital Setting

    International Nuclear Information System (INIS)

    Purpose: Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia. Methods and Materials: The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008, and April 12, 2012. Results: A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy. Conclusions: This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers

  8. Tapia's Syndrome after Posterior Cervical Spine Surgery under General Anesthesia

    OpenAIRE

    Park, Chang Kyu; Lee, Dong Chan; Park, Chan Joo; Hwang, Jang Hoe

    2013-01-01

    We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia's syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia's syndrome after endotracheal general anesthesia is believed to be due to p...

  9. The Advantages of Continuous Epidural Anesthesia in Spinal Deformity Surgery

    Directory of Open Access Journals (Sweden)

    Ezhevskaya А.А.

    2014-09-01

    Full Text Available The aim of the investigation was to assess the efficacy of epidural anesthesia and analgesia during the integrated anesthetic management in spinal deformity surgery. Materials and Methods. The prospective randomized study involved 350 patients aged from 15 to 65 years, divided into two groups: group 1 (n=205 were given combined anesthesia — epidural and endotracheal anesthesia with sevoflurane and continuous epidural analgesia with ropivacaine, fentanyl and epinephrine after surgery; group 2 (n=145 had general anesthesia with sevoflurane and fentanyl, and systemic administration of opioids after surgery. We assessed systemic hemodynamics parameters (a non-invasive method, pain at rest and activities, parameters of hemostasis and fibrinolysis, plasma levels of stress hormones, cytokine levels at seven stages of the study (before, during and three days after surgery. Results. Patients in group 1 with epidural anesthesia had significantly less pain both at rest and motion. The most blood saving effect (up to 60% of blood loss was also found in group 1. Hemodynamic monitoring demonstrated epidural anesthesia not to lead to the life-threatening events of myocardial contractility, cardiac output, systemic vascular resistance and critical increasing of extravascular lung water. The impact of epidural anesthesia on hemostasis encompassed the activation of both coagulation and fibrinolysis. Furthermore, patients in group 1 compared to group 2 had significantly lower plasma levels of glucose, lactate, С-reactive protein, cortisol, and interleukins IL-1β, IL-6, IL-10. Conclusion. Comprehensive anesthetic protection in spinal deformity surgery based on epidural anesthesia provides adequate antinociceptive effects, inhibition of endocrine and metabolic stress response and correction of hemostasis problems.

  10. An essential role for orexins in emergence from general anesthesia

    OpenAIRE

    Kelz, Max B.; Sun, Yi; Chen, Jingqiu; Cheng Meng, Qing; Moore, Jason T.; Veasey, Sigrid C.; Dixon, Shelley; Thornton, Marcus; Funato, Hiromasa; Yanagisawa, Masashi

    2008-01-01

    The neural mechanisms through which the state of anesthesia arises and dissipates remain unknown. One common belief is that emergence from anesthesia is the inverse process of induction, brought about by elimination of anesthetic drugs from their CNS site(s) of action. Anesthetic-induced unconsciousness may result from specific interactions of anesthetics with the neural circuits regulating sleep and wakefulness. Orexinergic agonists and antagonists have the potential to alter the stability o...

  11. Simultaneous Bilateral Cataract Surgery in General Anesthesia Patients

    OpenAIRE

    Tien-En Huang; Hsi-Kung Kuo; Sue-Ann Lin; Po-Chiung Fang; Pei-Chang Wu; Yi-Hao Chen; Yung-Jen Chen

    2007-01-01

    Background: The aim of this study was to evaluate the indications, safety, benefits, disadvantagesand advantages, and the visual outcomes for simultaneous bilateralcataract surgery (SBCS) under general anesthesia.Methods: This retrospective case review pertained to a period spanning from June1998 through June 2005 inclusively, and comprised of 27 consecutivepatients (54 eyes) that underwent simultaneous bilateral cataract surgeryunder general anesthesia at the Kaohsiung Chang Gung Memorial Ho...

  12. Can Local Anesthesia Prevent the Injury of Brachial Plexus?

    OpenAIRE

    Alaattin Ozturk

    2014-01-01

    Schwannomas (neurilemmomas) are benign tumors arising from peripheral nerve sheaths. They can be seen all over the body, but approximately half of the cases occur in the head and neck region. The schwannoma arising from brachial plexus is a rare cause of neck masses. They are rarely diagnosed preoperatively. The risk of nerve damage after excision is high under general anesthesia. In this article, a case of brachial plexus schwannoma was presented and the excision with local anesthesia was sh...

  13. Active Emergence from Propofol General Anesthesia Is Induced by Methylphenidate

    OpenAIRE

    Chemali, Jessica J.; Van Dort, Christa J.; Brown, Emery N.; Solt, Ken

    2011-01-01

    Background: A recent study showed that methylphenidate induces emergence from isoflurane general anesthesia. Isoflurane and propofol are general anesthetics that may have distinct molecular mechanisms of action. The objective of this study was to test the hypothesis that methylphenidate actively induces emergence from propofol general anesthesia. Methods: Using adult rats, the effect of methylphenidate on time to emergence after a single bolus of propofol was determined. The ability of met...

  14. Effect of Tramadol on Medetomidine and Ketamine Anesthesia in Dogs

    Directory of Open Access Journals (Sweden)

    W. Choi, H. S. Jang, S. H. Yun, J. S. Park, Y. S. Kwon and K. H. Jang*

    2011-04-01

    Full Text Available The analgesic effects of three different doses of tramadol as a preanesthetic in medetomidine-ketamine anesthesia in dogs were compared. Twenty-eight healthy adult mongrel dogs were used. The dogs were divided into four groups at random; 1 ml kg-1 of normal saline, 1, 2 or 4mg kg-1 of tramadol premedication (group Control, TRA1, TRA2 and TRA4 was then administered intravenously followed by medetomidine and ketamine anesthesia. The behavioral changes, the duration of surgical anesthesia, blood gas parameters (pH, pO2, and pCO2, heart rate, and systolic/diastolic pressure were observed. Tramadol (4mg kg-1 pretreatment significantly increased the degree of sedation when compared with the control, TRA1 and TRA2 groups at 15 min after tramadol administration (P<0.05. The duration of surgical anesthesia was significantly increased by tramadol (4mg kg-1 pretreatment when compared with that of the control group (P<0.05. There were no significant differences in behavioral changes, blood gas parameters (pH, pO2 and pCO2, heart rate, and arterial pressure among the groups. Tramadol at 4mg kg-1 did not affect the cardiovascular system and recovery of anesthesia, but significantly increased the duration of surgical anesthesia with medetomidine and ketamine. This result suggests that intravenous tramadol at 4mg kg-1 is a useful preanesthetic agent for extending the surgical level of anesthesia in medetomidine-ketamine anesthesia in dogs.

  15. Electroencephalographic Variation during End Maintenance and Emergence from Surgical Anesthesia

    OpenAIRE

    Divya Chander; García, Paul S.; MacColl, Jono N.; Sam Illing; Sleigh, Jamie W

    2014-01-01

    The re-establishment of conscious awareness after discontinuing general anesthesia has often been assumed to be the inverse of loss of consciousness. This is despite the obvious asymmetry in the initiation and termination of natural sleep. In order to characterize the restoration of consciousness after surgery, we recorded frontal electroencephalograph (EEG) from 100 patients in the operating room during maintenance and emergence from general anesthesia. We have defined, for the first time, 4...

  16. Oral transmucosal fentanyl pretreatment for outpatient general anesthesia.

    OpenAIRE

    Moore, P. A.; Cuddy, M. A.; Magera, J. A.; Caputo, A. C.; A.H. Chen; Wilkinson, L. A.

    2000-01-01

    The oral transmucosal formulation of fentanyl citrate (OTFC) has been reported to be an effective sedative, providing convenient and atraumatic sedation for children prior to general anesthesia or painful diagnostic procedures. Thirty-three young children (24-60 months of age) scheduled for outpatient general anesthesia for treatment of dental caries were enrolled in this randomized placebo-controlled clinical trial. To determine the effectiveness of the OTFC premedication, patient behavior w...

  17. Neuropeptide alterations in the tree shrew hypothalamus during volatile anesthesia

    OpenAIRE

    Fouillen, Laetitia; Petruzziello, Filomena; Veit, Julia; Bhattacharyya, Anwesha; Kretz, Robert; Rainer, Gregor; Zhang, Xiaozhe

    2013-01-01

    Neuropeptides are critical signaling molecules, involved in the regulation of diverse physiological processes including energy metabolism, pain perception and brain cognitive state. Prolonged general anesthesia has an impact on many of these processes, but the regulation of peptides by general anesthetics is poorly understood. In this study, we present an in-depth characterization of the hypothalamic neuropeptides of the tree shrew during volatile isoflurane/nitrous oxide anesthesia administe...

  18. Succinylcholine Use in Adult Anesthesia – A Multinational Questionnaire Survey

    OpenAIRE

    Karanović, Nenad; CAREV, MLADEN; Kardum, Goran; Tomanović, Nikac; Stuth, Eckehard; Gal, Janos; Tonković-Capin, Mislav; Đogaš, Varja; Račić, Goran; Đogaš, Zoran

    2011-01-01

    There are no definitive evidence based standards regarding use of succinylcholine (SCh) for anesthesia induction. However, there is a global trend toward eliminating SCh not only in elective, but also in emergency surgery in adults. The aim of the study was to survey the use of SCh in adult elective and emergency anesthesia practice in several European countries and the United States by questionnaire. One hundred and seventy anesthesiologists out of 201 possible, from six institutions in five...

  19. Issues of critical airway management (Which anesthesia; which surgical airway?)

    OpenAIRE

    Fabrizio Giuseppe Bonanno

    2012-01-01

    Which anesthesia for patients with critical airway? Safe and effective analgesia and anesthesia in critical airway is a skilled task especially after severe maxillofacial injury combined with head injury and hemorrhagic shock. If on one side sedation is wanted, on the other hand it may worsen the airway and hemodynamic situation to a point where hypoventilation and decrease of blood pressure, common side-effect of many opioids, may prejudice the patient′s level of consciousness and hemodynami...

  20. High Satisfaction with Problem-Based Learning for Anesthesia.

    OpenAIRE

    Chia-Hung Chang; Ching-Yue Yang; Lai-Chu See; Ping-Wing Lui

    2004-01-01

    Background: The aim of this study was to compare students' satisfaction between problem-based learning (PBL) and lecture-based traditional teaching of anesthesia.Methods: One hundred and thirty-seven fifth-year medical students were enrolled in acourse which used a hybrid curriculum for teaching about anesthesia. Thehybrid curriculum included 9 essential lectures and 3 related PBL case discussions.A Linkert 5-point scale was used for to assess students' satisfactionlevels between PBL and lect...

  1. A survey of user acceptance of electronic patient anesthesia records

    OpenAIRE

    Jin, Hyun Seung; Kim, Myung Hee; Lee, Suk Young; Jeong, Hui Yeon; Choi, Soo Joo; Lee, Hye Won

    2012-01-01

    Background An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). Methods A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administer...

  2. Safety of warfarin therapy during cataract surgery under topical anesthesia

    OpenAIRE

    2015-01-01

    ABSTRACT Purpose: To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia. Methods: This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30) and a control (n=30) group. Results: There were no records of intraoperative or postoperative intracameral bleeding complications ...

  3. CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas

    International Nuclear Information System (INIS)

    Today's practice of medicine involves ever more complex patients whose care is coordinated with multidisciplinary teams. Caring for these patients can challenge all members of the health care team. Sedation/anesthesia in infants/toddlers as well as uncooperative or intellectually or emotionally impaired children who require imaging studies of the chest are ongoing challenges. High-quality computed tomography (CT) chest imaging studies in children under general anesthesia are extremely important for accurate interpretation and subsequent medical decision-making. Anesthesia-induced atelectasis may obscure or mimic true pathology creating a significant quality issue. Obtaining a high-quality, motion-free chest imaging study in infants and children under general anesthesia remains a difficult task in many institutions. Meticulous attention to anesthesia and imaging techniques and specialized knowledge are required to properly perform and interpret chest imaging studies. In this commentary, we discuss the continuous struggle to obtain high-quality CT chest imaging under general anesthesia. We will also discuss the major concerns of the anesthesiologist, radiologist and pulmonologist and why cooperation and coordination among these providers are critical for an optimal quality study.

  4. Review of pharmacokinetic models for target controlled infusions in anesthesia

    Directory of Open Access Journals (Sweden)

    Subash Kennedy Sivasubramaniam

    2014-06-01

    Full Text Available Intravenous injection of anesthetic drugs dates back to the 17th Century when opium and chloral hydrate have been injected intravenously. It was not until the 1930s intravenous anesthesia became popular with the invention of barbiturates.Early intravenous anesthetic agents such as barbiturates were ideal for induction of anesthesia, but not suitable for maintenance of anesthesia. Most of these drugs accumulated significantly with increasing durations of infusion and also resulted in cardiorespiratory depression. The invention of propofol and shorter acting opioid analgesics such as remifentanil and alfentanil have revolutionized intravenous anesthesia. The rapid onset and offset of these drugs lends itself to being suitable agents for maintenance of anesthesia over prolonged periods of time. Detailed understanding of the pharmacokinetics of propofol and remifentanil, combined with technological advances in intravenous pumps capable of accurate delivery of drugs have resulted in great development of the field of total intravenous anesthesia and target controlled infusions. I would like to discuss, in this article, the pharmacokinetics and pharmacokinetic models behind these intravenous infusion pumps. [Int J Basic Clin Pharmacol 2014; 3(3.000: 417-423

  5. CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas

    Energy Technology Data Exchange (ETDEWEB)

    Mahmoud, Mohamed [Cincinnati Children' s Hospital Medical Center, Department of Anesthesiology, Cincinnati, OH (United States); Towe, Christopher [Cincinnati Children' s Hospital Medical Center, Department of Pulmonary Medicine, Cincinnati, OH (United States); Fleck, Robert J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2015-07-15

    Today's practice of medicine involves ever more complex patients whose care is coordinated with multidisciplinary teams. Caring for these patients can challenge all members of the health care team. Sedation/anesthesia in infants/toddlers as well as uncooperative or intellectually or emotionally impaired children who require imaging studies of the chest are ongoing challenges. High-quality computed tomography (CT) chest imaging studies in children under general anesthesia are extremely important for accurate interpretation and subsequent medical decision-making. Anesthesia-induced atelectasis may obscure or mimic true pathology creating a significant quality issue. Obtaining a high-quality, motion-free chest imaging study in infants and children under general anesthesia remains a difficult task in many institutions. Meticulous attention to anesthesia and imaging techniques and specialized knowledge are required to properly perform and interpret chest imaging studies. In this commentary, we discuss the continuous struggle to obtain high-quality CT chest imaging under general anesthesia. We will also discuss the major concerns of the anesthesiologist, radiologist and pulmonologist and why cooperation and coordination among these providers are critical for an optimal quality study.

  6. Electroencephalographic variation during end maintenance and emergence from surgical anesthesia.

    Science.gov (United States)

    Chander, Divya; García, Paul S; MacColl, Jono N; Illing, Sam; Sleigh, Jamie W

    2014-01-01

    The re-establishment of conscious awareness after discontinuing general anesthesia has often been assumed to be the inverse of loss of consciousness. This is despite the obvious asymmetry in the initiation and termination of natural sleep. In order to characterize the restoration of consciousness after surgery, we recorded frontal electroencephalograph (EEG) from 100 patients in the operating room during maintenance and emergence from general anesthesia. We have defined, for the first time, 4 steady-state patterns of anesthetic maintenance based on the relative EEG power in the slow-wave (awareness after drug discontinuation. Moreover, these emergence patterns could be broadly grouped according to the duration and rapidity of transitions amongst these slow-wave dominated brain states that precede awakening. Most patients progressed gradually from a pattern characterized by strong peaks of delta (0.5-4 Hz) and alpha/spindle (8-14 Hz) power ('Slow-Wave Anesthesia') to a state marked by low delta-spindle power ('Non Slow-Wave Anesthesia') before awakening. However, 31% of patients transitioned abruptly from Slow-Wave Anesthesia to waking; they were also more likely to express pain in the post-operative period. Our results, based on sleep-staging classification, provide the first systematized nomenclature for tracking brain states under general anesthesia from maintenance to emergence, and suggest that these transitions may correlate with post-operative outcomes such as pain. PMID:25264892

  7. Combining isoflurane anesthesia with midazolam and butorphanol in rats.

    Science.gov (United States)

    Tsukamoto, Atsushi; Uchida, Kaho; Maesato, Shizuka; Sato, Reiichiro; Kanai, Eiichi; Inomata, Tomo

    2016-07-29

    Representative inhalant anesthetic agent, isoflurane is commonly used during surgery in rats. However, isoflurane mediates relatively strong respiratory depression. In human and veterinary medicine, sedatives and analgesics are co-administered to complement the anesthetic action of inhalant anesthesia. The present study aimed to establish the novel balanced anesthesia that combines midazolam and butorphanol with isoflurane (MBI) in rats. Male Sprague Dawley rats were divided into 2 groups, and administered either isoflurane monoanesthesia or isoflurane with midazolam (2.5 mg/kg, ip) and butorphanol (2.0 mg/kg, ip). The minimum alveolar concentration (MAC) in each group was evaluated. Induction and recovery times were measured in each group. Adverse reactions during induction were also recorded. In each group, vital signs were assessed for 1 h under 1.5×MAC of isoflurane. Instability of vital signs was assessed under each anesthesia by calculating coefficient of variance. Compared with isoflurane monoanesthesia, MBI anesthesia caused 32% MAC reduction (isoflurane monoanesthesia: 1.30 ± 0.09%, MBI 0.87 ± 0.08%, PMBI anesthesia resulted in a relatively stable respiratory rate without decreases in SPO2 during the anesthetic period. In summary, MB premedication is effective for attenuating respiratory depression induced by isoflurane, and achieving smooth induction. This anesthetic protocol serves as a novel option for appropriate anesthesia in rats. PMID:26876437

  8. Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients

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    Chetana Sachin Makade

    2014-01-01

    Full Text Available Introduction: Intraoral local anesthesia is essential for delivering dental care. Needless devices have been developed to provide anesthesia without injections. Little controlled research is available on its use in dental restorative procedures in adult patients. The aims of this study were to compare adult patients acceptability and preference for needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Materials and Methods: Twenty non fearful adults with no previous experience of dental anesthesia were studied using split-mouth design. The first procedure was performed with classical needle infiltration anesthesia. The same amount of anesthetic solution was administered using MADA jet needleless device in a second session one week later, during which a second dental restorative procedure was performed. Patients acceptance was assessed using Universal pain assessment tool while effectiveness was recorded using soft tissue anesthesia and pulpal anesthesia. Patients reported their preference for the anesthetic method at the third visit. The data was evaluated using chi square test and student′s t-test. Results: Pressure anesthesia was more accepted and preferred by 70% of the patients than traditional needle anesthesia (20%. Both needle and pressure anesthesia was equally effective for carrying out the dental procedures. Conclusion: Patients experienced significantly less pain and fear (p<0.01 during anesthetic procedure with pressure anesthesia. However, for more invasive procedures needle anesthesia will be more effective.

  9. Changes in intraocular pressures during laparoscopy: a comparison of propofol total intravenous anesthesia to desflurane-thiopental anesthesia.

    Science.gov (United States)

    Asuman, Arslan Onuk; Baris, Arslan; Bilge, Karsli; Bozkurt, Selen; Nurullah, Bülbüler; Meliha, Kahraman; Umit, Celik

    2013-02-01

    The aim of the study was to examine intraocular pressure (IOP) changes during laparoscopic cholecystectomy performed under either desflurane-thiopental anesthesia or propofol total intravenous anesthesia (TIVA). 36 patients who will undergo elective laparoscopic cholecystectomy were enrolled in the study. The patients were randomly divided into one of two groups: desflurane (Group D, n=18) or propofol (Group P, n=18). All patients received fentanyl 2 micro/kg IV, and then breathed 100% oxygen for 3 minutes prior to induction of anesthesia. Anesthesia was induced by using thiopental 5 mg/kg IV in Group D and 2 mg/kg IV propofol in group P. Neuromuscular block was achieved with rocuronium 0.6 mg/kg IV. Anesthesia was maintained with desflurane 3-6% in group D and propofol infusion 5-10 mg/kg/h in group P. Desflurane and propofol concentrations were adjusted to maintain mean arterial pressure witihin 20% of the preinduction value. During anaesthesia, fractionated doses of fentanyl 0.5-1 micro g /kg IV and maintenance doses of muscle relaxants were used. In both groups, the the mixture 60% nitrous oxide and 40% oxygen was administered used. Arterial pressure, heart rate, ETCO2, SpO2 and IOP were recorded at the predefined time points. Creation of pneumoperitoneum resulted in a significant increase in IOP which remained elevated throughout the operation in both groups. Also, we recorded a similar IOP changes with both techniques except at five minutes after pneumoperitoneum in 15 degrees reverse Trendelenburg position during desflurane-thiopental anesthesia. In c6nclusion, desflurane-thiopental anesthesia maintains the IOP at least at similar levels compared to propofol TIVA anesthesia. PMID:23833850

  10. Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

    OpenAIRE

    Kyu-Jin Chung; Kyu-Ho Cha; Jun-Ho Lee; Yong-Ha Kim; Tae-Gon Kim; Il-Guk Kim

    2012-01-01

    Background Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anest...

  11. Anesthesia cutoff phenomenon: Interfacial hydrogen bonding

    International Nuclear Information System (INIS)

    Anesthesia cutoff refers to the phenomenon of loss of anesthetic potency in a homologous series of alkanes and their derivatives when their sizes become too large. In this study, hydrogen bonding of 1-alkanol series (ethanol to eicosanol) to dipalmitoyl-L-alpha-phosphatidylcholine (DPPC) was studied by Fourier transform infrared spectroscopy (FTIR) in DPPC-D2O-in-CCl4 reversed micelles. The alkanols formed hydrogen bonds with the phosphate moiety of DPPC and released the DPPC-bound deuterated water, evidenced by increases in the bound O-H stretching signal of the alkanol-DPPC complex and also in the free O-D stretching band of unbound D2O. These effects increased according to the elongation of the carbon chain of 1-alkanols from ethanol (C2) to 1-decanol (C10), but suddenly almost disappeared at 1-tetradecanol (C14). Anesthetic potencies of these alkanols, estimated by the activity of brine shrimps, were linearly related to hydrogen bond-breaking activities below C10 and agreed with the FTIR data in the cutoff at C10

  12. [The history of anesthesia apparatus: basic principles].

    Science.gov (United States)

    Wawersik, J

    1982-10-01

    The beginnings of modern anesthetic equipment date back to Morton's inhalation flagon in 1846. The numerous devices developed and introduced subsequently can be divided into four groups: 1. Simple ether and chloroform masks for open inhalation anesthesia, from Simpson (1847) to Brown (1928). 2. Vapour inhalators according to the "draw over" principle of Snow (1847) up to the Oxford vaporizer (1941). 3. Closed or half-closed inhalation equipment for ether or chloroform with to and fro breathing, from Clover (1877) to Ombredanne (1908). 4. Equipment for anaesthesia with nitrous oxide. From 1868 onwards this led to the incorporation of gas bottles in anaesthetic equipment and between 1885 and 1890 to the construction of mixing-valves for nitrous oxide and oxygen. In addition, reducing valves, flow meters and vaporizers were developed. The first anaesthetic apparatus with circle system and CO2-absorber was constructed in 1925 by the Dräger factory in Lübeck. Sudeck and Schmidt introduced this technique of anaesthesia in the university hospital of Hamburg-Eppendorf between 1920 and 1925. PMID:6758628

  13. Reactive Software Agent Anesthesia Decision Support System

    Directory of Open Access Journals (Sweden)

    Grant H. Kruger

    2011-12-01

    Full Text Available Information overload of the anesthesiologist through technological advances have threatened the safety of patients under anesthesia in the operating room (OR. Traditional monitoring and alarm systems provide independent, spatially distributed indices of patient physiological state. This creates the potential to distract caregivers from direct patient care tasks. To address this situation, a novel reactive agent decision support system with graphical human machine interface was developed. The system integrates the disparate data sources available in the operating room, passes the data though a decision matrix comprising a deterministic physiologic rule base established through medical research. Patient care is improved by effecting change to the care environment by displaying risk factors and alerts as an intuitive color coded animation. The system presents a unified, contextually appropriate snapshot of the patient state including current and potential risk factors, and alerts of critical patient events to the operating room team without requiring any user intervention. To validate the efficacy of the system, a retrospective analysis focusing on the hypotension rules were performed. Results show that even with vigilant and highly trained clinicians, deviations from ideal patient care exist and it is here that the proposed system may allow more standardized and improved patient care and potentially outcomes.

  14. Electroencephalographic variation during end maintenance and emergence from surgical anesthesia.

    Directory of Open Access Journals (Sweden)

    Divya Chander

    Full Text Available The re-establishment of conscious awareness after discontinuing general anesthesia has often been assumed to be the inverse of loss of consciousness. This is despite the obvious asymmetry in the initiation and termination of natural sleep. In order to characterize the restoration of consciousness after surgery, we recorded frontal electroencephalograph (EEG from 100 patients in the operating room during maintenance and emergence from general anesthesia. We have defined, for the first time, 4 steady-state patterns of anesthetic maintenance based on the relative EEG power in the slow-wave (<14 Hz frequency bands that dominate sleep and anesthesia. Unlike single-drug experiments performed in healthy volunteers, we found that surgical patients exhibited greater electroencephalographic heterogeneity while re-establishing conscious awareness after drug discontinuation. Moreover, these emergence patterns could be broadly grouped according to the duration and rapidity of transitions amongst these slow-wave dominated brain states that precede awakening. Most patients progressed gradually from a pattern characterized by strong peaks of delta (0.5-4 Hz and alpha/spindle (8-14 Hz power ('Slow-Wave Anesthesia' to a state marked by low delta-spindle power ('Non Slow-Wave Anesthesia' before awakening. However, 31% of patients transitioned abruptly from Slow-Wave Anesthesia to waking; they were also more likely to express pain in the post-operative period. Our results, based on sleep-staging classification, provide the first systematized nomenclature for tracking brain states under general anesthesia from maintenance to emergence, and suggest that these transitions may correlate with post-operative outcomes such as pain.

  15. Effects of propofol anesthesia and sevoflurane anesthesia on the differentiation of human T-helper cells during surgery

    Institute of Scientific and Technical Information of China (English)

    JI Fu-hai; WANG Yu-lan; YANG Jian-ping

    2011-01-01

    Background Surgical stress causes a helper T-cell type 2 (Th2)-dominant status and disturbs the Th1/Th2 cytokine balance. Anesthesia can suppress the stress response to surgery, therefore it may inhibit the imbalance in the Th1/Th2 ratio. In this study, we assessed if propofol anesthesia and sevoflurane anesthesia influence the Th1/Th2 cytokine balance, and which anesthesia method better attenuates this ratio.Methods Twenty-eight patients with an American Society of Anesthesiologists (ASA) physical status of I undergoing laparoscopic cholecystectomy were selected. They were randomly allocated into two groups of 14. Group 1 received propofol anesthesia by a target-controlled-infusion (TCI) pump and group 2 received sevoflurane anesthesia.Non-invasive blood pressure, heart rate, and end-expiration CO2 partial pressure were monitored during anesthesia. The depth of anesthesia was measured using the bispectral index (BIS), and maintained between 50 and 60. During surgery we adjusted the doses of propofol and sevoflurane according to the BIS. Samples of peripheral blood were taken before the induction of anesthesia (T1), after the induction of anesthesia (T2), at the beginning of surgery (T3), at the end of surgery (T4) and on the first day after surgery (D1). Blood samples were analyzed to give the Th1/Th2 ratio and plasma level of cortisol.Results Non-invasive blood pressure, heart rate and end-expiration CO2 partial pressure were not notably different in the two groups. At T4, the percentage of T1 cells was higher in group 1 and had statistical significance (P <0.05). The percentage of T2 cells was not significantly different in the two groups. At T4, the difference in the Th1/Th2 ratio was significantly different. At T3, T4, and D1, the plasma level of cortisol was lower in group 1(P <0.05).Conclusion Compared with sevoflurane, propofol can preferably promote Th cells to differentiate into Th1 cells and inhibit surgical stress. Propofol may therefore be

  16. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2014-01-01

    Full Text Available Aims: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with all patients undergoing LC under spinal anesthesia in our department since 2007. Settings and Design: Prospective observational. Materials and Methods: From 2007 to 2011, 369 patients with symptoms of colelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO 2. We compared 15 mg of hyperbaric bupivacaine and lumbar puncture with 10 or 7.5 mg of hyperbaric bupivacaine thoracic puncture, all with 25 μg fentanyl until the sensory level reached T 3 . Intraoperative parameters, post-operative pain, complications, recovery, patient satisfaction, and cost were compared between both groups. Statistical Analysis Used: Means were compared by ANOVA or Kruskal-Wallis test, the percentages of the Chi-square test or Fisher′s exact test when appropriate. Time of motor and sensory block in spinal anesthesia group was compared by paired t test or Mann-Whitney test. Differences were considered significant when P ≤ 0.05, and for comparisons of mean pain visual scale, we employed the Bonferroni correction applied to be considered significant only with P ≤ 0.0125 Results: All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 329 (89% patients. There were significant differences in time to reach T 3 , obtaining 15 mg > 10 mg = 7.5 mg. There is a positive correlation between the dose and the incidence of hypotension. The lowest doses gave a decrease of 52.2% in the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With low doses, 60% of patients went from table to stretcher

  17. Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

    Directory of Open Access Journals (Sweden)

    Kyu-Jin Chung

    2012-09-01

    Full Text Available Background Patients have anxiety and fear of complications due to general anesthesia.Through new instruments and local anesthetic drugs, a variety of anesthetic methods havebeen introduced. These methods keep hospital costs down and save time for patients. Inparticular, the target-controlled infusion (TCI system maintains a relatively accurate level ofplasma concentration, so the depth of anesthesia can be adjusted more easily. We conductedthis study to examine whether intravenous anesthesia using the TCI system with propofol andremifentanil would be an effective method of anesthesia in breast augmentation.Methods This study recruited 100 patients who underwent breast augmentation surgeryfrom February to August 2011. Intravenous anesthesia was performed with 10 mg/mLpropofol and 50 μg/mL remifentanil simultaneously administered using two separate modulesof a continuous computer-assisted TCI system. The average target concentration was set at2 μg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinicaleffect and vital signs. Oxygen saturation, electrocardiography, and respiratory status werecontinuously measured during surgery. Blood pressure was measured at 5-minute intervals.Information collected includes total duration of surgery, dose of drugs administered duringsurgery, memory about surgery, and side effects.Results Intraoperatively, there was transient hypotension in two cases and hypoxia in threecases. However, there were no serious complications due to anesthesia such as respiratorydifficulty, deep vein thrombosis, or malignant hypertension, for which an endotrachealintubation or reversal agent would have been needed. All the patients were discharged on theday of surgery and able to ambulate normally.Conclusions Our results indicate that anesthetic methods, where the TCI of propofol andremifentanil is used, might replace general anesthesia with endotracheal intubation in breastaugmentation surgery.

  18. Permutation auto-mutual information of electroencephalogram in anesthesia

    Science.gov (United States)

    Liang, Zhenhu; Wang, Yinghua; Ouyang, Gaoxiang; Voss, Logan J.; Sleigh, Jamie W.; Li, Xiaoli

    2013-04-01

    Objective. The dynamic change of brain activity in anesthesia is an interesting topic for clinical doctors and drug designers. To explore the dynamical features of brain activity in anesthesia, a permutation auto-mutual information (PAMI) method is proposed to measure the information coupling of electroencephalogram (EEG) time series obtained in anesthesia. Approach. The PAMI is developed and applied on EEG data collected from 19 patients under sevoflurane anesthesia. The results are compared with the traditional auto-mutual information (AMI), SynchFastSlow (SFS, derived from the BIS index), permutation entropy (PE), composite PE (CPE), response entropy (RE) and state entropy (SE). Performance of all indices is assessed by pharmacokinetic/pharmacodynamic (PK/PD) modeling and prediction probability. Main results. The PK/PD modeling and prediction probability analysis show that the PAMI index correlates closely with the anesthetic effect. The coefficient of determination R2 between PAMI values and the sevoflurane effect site concentrations, and the prediction probability Pk are higher in comparison with other indices. The information coupling in EEG series can be applied to indicate the effect of the anesthetic drug sevoflurane on the brain activity as well as other indices. The PAMI of the EEG signals is suggested as a new index to track drug concentration change. Significance. The PAMI is a useful index for analyzing the EEG dynamics during general anesthesia.

  19. 25 gauge vitrectomy under topical anesthesia: A pilot study

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    Raju Biju

    2006-01-01

    Full Text Available Aims: To evaluate the safety and efficacy of transconjunctival 25 gauge vitrectomy under topical anesthesia. Settings and Design: A pilot study of consecutive cases which underwent 25 gauge vitrectomy under topical anesthesia. Materials and Methods: Seven eyes of 7 patients underwent 25 gauge vitrectomy under topical anesthesia with a pledget soaked in anesthetic, for vitreous hemorrhage (2 eyes, retained cortex (1 eye and postoperative endophthalmitis (4 eyes. Subjective pain and discomfort were graded from 0 (no pain or discomfort to 4 (severe pain and discomfort. Patients underwent an immediate postoperative assessment, followed by day one and one week postoperative evaluation. Results: All patients had grade 0 pain during the surgery. Five patients had grade 2 pain during the placement of the sclerotomies. None of the patients required any sedation during the procedure. No inadvertent eye movements were noted during surgery. Except one patient, none required postoperative analgesics. Five eyes had a favorable outcome. No eyes in this pilot study had any procedure-related complications. Conclusion: With appropriate case selection, topical anesthesia is a safe and effective alternative to infiltrative anesthesia for 25 gauge vitrectomy. A larger series of patients with a longer follow-up is required to validate the findings of this pilot study.

  20. Modeling the dynamical effects of anesthesia on brain circuits.

    Science.gov (United States)

    Ching, Shinung; Brown, Emery N

    2014-04-01

    General anesthesia is a neurophysiological state that consists of unconsciousness, amnesia, analgesia, and immobility along with maintenance of physiological stability. General anesthesia has been used in the United States for more than 167 years. Now, using systems neuroscience paradigms how anesthetics act in the brain and central nervous system to create the states of general anesthesia is being understood. Propofol is one of the most widely used and the most widely studied anesthetics. When administered for general anesthesia or sedation, the electroencephalogram (EEG) under propofol shows highly structured, rhythmic activity that is strongly associated with changes in the patient's level of arousal. These highly structured oscillations lend themselves readily to mathematical descriptions using dynamical systems models. We review recent model descriptions of the commonly observed EEG patterns associated with propofol: paradoxical excitation, strong frontal alpha oscillations, anteriorization and burst suppression. Our analysis suggests that propofol's actions at GABAergic networks in the cortex, thalamus and brainstem induce profound brain dynamics that are one of the likely mechanisms through which this anesthetic induces altered arousal states from sedation to unconsciousness. Because these dynamical effects are readily observed in the EEG, the mathematical descriptions of how propofol's EEG signatures relate to its mechanisms of action in neural circuits provide anesthesiologists with a neurophysiologically based approach to monitoring the brain states of patients receiving anesthesia care. PMID:24457211

  1. Non-invasive anesthesia for children undergoing proton radiation therapy

    International Nuclear Information System (INIS)

    Background: Proton therapy is a newer modality of radiotherapy during which anesthesiologists face specific challenges related to the setup and duration of treatment sessions. Purpose: Describe our anesthesia practice for children treated in a standalone proton therapy center, and report on complications encountered during anesthesia. Materials and methods: A retrospective review of anesthetic records for patients ⩽18 years of age treated with proton therapy at our institution between January 2006 and April 2013 was performed. Results: A total of 9328 anesthetics were administered to 340 children with a median age of 3.6 years (range, 0.4–14.2). The median daily anesthesia time was 47 min (range, 15–79). The average time between start of anesthesia to the start of radiotherapy was 7.2 min (range, 1–83 min). All patients received Total Intravenous Anesthesia (TIVA) with spontaneous ventilation, with 96.7% receiving supplemental oxygen by non-invasive methods. None required daily endotracheal intubation. Two episodes of bradycardia, and one episode each of; seizure, laryngospasm and bronchospasm were identified for a cumulative incidence of 0.05%. Conclusions: In this large series of children undergoing proton therapy at a freestanding center, TIVA without daily endotracheal intubation provided a safe, efficient, and less invasive option of anesthetic care

  2. Limitation in monitoring depth of anesthesia: a case report.

    Science.gov (United States)

    Cascella, Marco; Bifulco, Francesca; Viscardi, Daniela; Tracey, Maura C; Carbone, Domenico; Cuomo, Arturo

    2016-04-01

    Although we describe a clinical situation that most likely occurs in hundreds of operatory rooms in the world, we report this case as provocation. It concerns an unexpected awakening from an appropriate depth of anesthesia, although the BIS monitor showed a BIS index of less than 50 for a prolonged period before and after the event. Approximately 30 min after induction of anesthesia, the patient had a hypothetic sudden arousal of consciousness, with spontaneous movements, facial muscle activation, intolerance to the tracheal tube, and tearing. After immediate intravenous administration of midazolam (4 mg), the patient returned to a depth of anesthesia status, and surgery was completed uneventfully. The patient had no recall of the event when questioned during the episode, at emergence, or at 24 h, 36 h, and 7 days after surgery. Were these events spinal reflexes to pain or stimulation although the cortex was still anesthetized? Maybe this is the more rational explanation. Was the patient awake but not aware? Is it possible that our patient experienced only a transient arousal from consciousness, and that he did not have recall because the arousal time was short and we blocked memory consolidation? The latter hypothesis provides an opportunity to discuss the evidence that at the moment there is no device to assess the depth of anesthesia. We also focus on the possibility of interfering with memory processing under anesthesia. PMID:26671259

  3. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

    Directory of Open Access Journals (Sweden)

    Rochana Girish Bakhshi

    2011-11-01

    Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

  4. High Satisfaction with Problem-Based Learning for Anesthesia.

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    Chia-Hung Chang

    2004-09-01

    Full Text Available Background: The aim of this study was to compare students' satisfaction between problem-based learning (PBL and lecture-based traditional teaching of anesthesia.Methods: One hundred and thirty-seven fifth-year medical students were enrolled in acourse which used a hybrid curriculum for teaching about anesthesia. Thehybrid curriculum included 9 essential lectures and 3 related PBL case discussions.A Linkert 5-point scale was used for to assess students' satisfactionlevels between PBL and lecture-based traditional teaching. Data were collectedthrough a year-end questionnaire over 2 academic years from 2002 to2003. Scores regarding the satisfaction levels between these 2 teaching methodswere analyzed using a 2-sided paired t-test.Results: Most students preferred PBL over the lecture-based traditional teaching inthe following 6 aspects: learning about anesthesia, understanding other medicalknowledge, being interested in and motivated to learn, training for futurework, training of personal abilities, and being confident and satisfied withthe teaching method ( p<0.05. However, traditional teaching was superiorto PBL in enhancing the speed of learning with greater understanding of abasic knowledge of anesthesia, as well as in providing more solid contentwith understanding of a greater number of anesthetic techniques ( p<0.05.Satisfaction levels with this curriculum did not generally differ between studentsenrolled in different classes in 2002 and 2003.Conclusions: Although the assessment tools and content of PBL need to be modified,implementation of PBL for teaching anesthesia showed satisfactory results.

  5. Implementation of an Anesthesia Information Management System (AIMS)

    Science.gov (United States)

    Douglas, James R.; Ritter, Melody J.

    2011-01-01

    During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care–related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges. PMID:21734847

  6. Delayed recovery from anesthesia: A postgraduate educational review.

    Science.gov (United States)

    Misal, Ullhas Sudhakarrao; Joshi, Suchita Annasaheb; Shaikh, Mudassir Mohd

    2016-01-01

    Delayed awakening from anesthesia remains one of the biggest challenges that involve an anesthesiologist. With the general use of fast-acting anesthetic agents, patients usually awaken quickly in the postoperative period. The time to emerge from anesthesia is affected by patient factors, anesthetic factors, duration of surgery, and painful stimulation. The principal factors responsible for delayed awakening following anesthesia are anesthetic agents and medications used in the perioperative period. Nonpharmacological causes may have a serious sequel, hence recognizing these organic conditions is important. Certain underlying metabolic disorders such as hypoglycemia, severe hyperglycemia, and electrolyte imbalance, especially hypernatremia, hypoxia, hypercapnia, central anticholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia, uremia, and severe hypothyroidism may also be responsible for delayed recovery following anesthesia. Unexpected delayed emergence after general anesthesia may also be due to intraoperative cerebral hypoxia, hemorrhage, embolism, or thrombosis. Accurate diagnosis of the underlying cause is the key for the institution of appropriate therapy, but primary management is to maintain airway, breathing, and circulation. This comprehensive review discusses the risk factors, causes, evaluation and management of delayed recovery based on our clinical experience, and literature search on the internet, supported by the standard textbooks of anesthesiology. PMID:27212741

  7. Safety of warfarin therapy during cataract surgery under topical anesthesia

    Directory of Open Access Journals (Sweden)

    Newton Kara-Junior

    2015-06-01

    Full Text Available ABSTRACT Purpose: To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia. Methods: This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30 and a control (n=30 group. Results: There were no records of intraoperative or postoperative intracameral bleeding complications in both the groups. At 1-month postoperative follow-up, 90.0% of patients presented spectacle-corrected visual acuity of at least 20/40. Conclusion: Cataract surgery by phacoemulsification with topical anesthesia can be successfully conducted without discontinuing warfarin.

  8. Effect of yohimbine on xylazine-ketamine anesthesia in cats.

    Science.gov (United States)

    Hsu, W H; Lu, Z X

    1984-10-15

    Xylazine and ketamine are an anesthetic combination used in feline practice for routine surgical procedures. In a controlled study, we evaluated the effects of yohimbine, an antagonist of xylazine, on the anesthesia induced by this anesthetic combination in cats. Two intramuscular doses of xylazine and ketamine (2.2 mg of xylazine/kg plus 6.6 mg of ketamine/kg and 4.4 mg of xylazine/kg plus 6.6 mg of ketamine/kg) caused approximately 60 and 100 minutes of anesthesia, respectively, in control cats. When yohimbine (0.1 mg/kg) was given intravenously 45 minutes after ketamine administration, the cats regained consciousness within 3 minutes. They were ambulatory 1 to 2 minutes after regaining consciousness. Yohimbine also reversed the bradycardia and respiratory depression elicited by xylazine-ketamine. The results indicated that yohimbine may be useful for controlling the duration of xylazine-ketamine anesthesia in cats. PMID:6501048

  9. Caudal anesthesia in a patient with peritonitis: Is it safe??

    Science.gov (United States)

    Kako, H; Hakim, M; Kundu, A; Tobias, T D

    2016-01-01

    Neuraxial anesthesia combined with general anesthesia has become a widely accepted method of providing effective postoperative analgesia and decreasing intraoperative anesthetic needs in the pediatric population. In clinical practice, there still appears to be hesitancy for the use of a neuraxial technique (spinal or epidural) in patients at risk for bacteremia or with an on-going systemic infection. However, evidence-based medicine lacks any data to support an increase in the risk of infectious complications following neuraxial anesthesia. We present two pediatric patients with intra-abdominal infectious processes who received caudal epidural blockade for postoperative operative analgesia. The use of neuraxial techniques in patients at risk for bacteremia is reviewed, evidence-based medicine regarding the risks of infection discussed, and the potential favorable effects of neuraxial blockade on the neurohumoral response to sepsis and the systemic inflammatory responses presented. PMID:27051378

  10. Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index

    NARCIS (Netherlands)

    C. Kerssens (Chantal); J. Klein (Jan); A. van der Woerd; B. Bonke (Benno)

    2001-01-01

    textabstractMemory for intraoperative events may arise from inadequate anesthesia when the hypnotic state is not continuously monitored. Electroencephalogram bispectral index (BIS) enables monitoring of the hypnotic state and titration of anesthesia to an adequate level

  11. Intranasal Insulin Prevents Anesthesia-Induced Spatial Learning and Memory Deficit in Mice

    Science.gov (United States)

    Zhang, Yongli; Dai, Chun-ling; Chen, Yanxing; Iqbal, Khalid; Liu, Fei; Gong, Cheng-Xin

    2016-01-01

    Elderly individuals are at increased risk of cognitive decline after anesthesia. General anesthesia is believed to be a risk factor for Alzheimer’s disease (AD). At present, there is no treatment that can prevent anesthesia-induced postoperative cognitive dysfunction. Here, we treated mice with daily intranasal administration of insulin (1.75 U/day) for one week before anesthesia induced by intraperitoneal injection of propofol and maintained by inhalation of sevoflurane for 1 hr. We found that the insulin treatment prevented anesthesia-induced deficit in spatial learning and memory, as measured by Morris water maze task during 1–5 days after exposure to anesthesia. The insulin treatment also attenuated anesthesia-induced hyperphosphorylation of tau and promoted the expression of synaptic proteins and insulin signaling in the brain. These findings show a therapeutic potential of intranasal administration of insulin before surgery to reduce the risk of anesthesia-induced cognitive decline and AD. PMID:26879001

  12. Cleft-lift operation for pilonidal sinuses under tumescent local anesthesia

    DEFF Research Database (Denmark)

    Bertelsen, Claus Anders

    2011-01-01

    The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before.......The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before....

  13. Acute Unilateral Parotid Glands Enlargement Following Endotracheal General Anesthesia: Report of Two Cases

    OpenAIRE

    Hung-Jr Chiou; Yuan-Ji Day; Allen H. Li; Jiin-Tarng Liou; Fu-Chao Liu

    2007-01-01

    Acute parotid gland enlargement in association with general anesthesia is rare and hasalso been called anesthesia mumps. We present two patients who were scheduled for lumbarspine surgery under general anesthesia. Each developed acute unilateral parotid glandenlargement over one side of the face proven by sonography. Case 1: A 52-year-old manwas scheduled for his third lumbar spine to first sacral spine surgery for scoliosis andspondylolisthesis. The patient was provided general anesthesia wi...

  14. Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Aasvang, Eske Kvanner

    2015-01-01

    Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding...... randomized controlled trials comparing modern general anesthesia and spinal anesthesia for knee and hip arthroplasty prevents final recommendations and calls for prospective detailed studies in this clinically important field....

  15. Comparison of Postoperative Events between Spinal Anesthesia and General Anesthesia in Laparoscopic Cholecystectomy: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Wang, Xian-Xue; Zhou, Quan; Deng, Hui-Wei; Zhou, Ai-Guo; Guo, Hua-Jing; Huang, Fu-Rong

    2016-01-01

    Background. Laparoscopic cholecystectomy is usually carried out under general anesthesia. There were a few studies which have found spinal anesthesia as a safe alternative. We aimed to evaluate the postoperative events between spinal anesthesia and general anesthesia in patients undergoing laparoscopic cholecystectomy. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to January 2016) for eligible studies. The primary outcome was the visual analogue scale score. Secondary outcomes included postoperative nausea and vomiting and urine retention 24 hours postoperatively. We calculated pooled risk ratios and 95% confidence interval using random- or fixed-effects models. Results. Eight trials involving 723 patients were listed. Meta-analysis showed that patients in spinal anesthesia groups have lower visual analogue scale score 24 hours postoperatively. There were significant decreases in the occurrence of postoperative nausea and vomiting in spinal anesthesia group when compared with general anesthesia group (odds ratios: 0.38, 95% confidence interval: 0.19–0.76; P = 0.006) with heterogeneity accepted (I2 = 13%; P = 0.33), while urine retention rate was increased in patients with spinal anesthesia (odds ratios: 4.95, 95% confidence interval: 1.24–19.71; P = 0.02) without any heterogeneity (I2 = 0%; P = 0.98). Conclusions. Spinal anesthesia may be associated with less postoperative pain and postoperative nausea and vomiting compared with general anesthesia. PMID:27525282

  16. Cortico-cardio-respiratory network interactions during anesthesia.

    Directory of Open Access Journals (Sweden)

    Yuri Shiogai

    Full Text Available General anesthetics are used during medical and surgical procedures to reversibly induce a state of total unconsciousness in patients. Here, we investigate, from a dynamic network perspective, how the cortical and cardiovascular systems behave during anesthesia by applying nonparametric spectral techniques to cortical electroencephalography, electrocardiogram and respiratory signals recorded from anesthetized rats under two drugs, ketamine-xylazine (KX and pentobarbital (PB. We find that the patterns of low-frequency cortico-cardio-respiratory network interactions may undergo significant changes in network activity strengths and in number of network links at different depths of anesthesia dependent upon anesthetics used.

  17. Anesthesia for plastic reconstruction surgery of radiation injury of neck

    International Nuclear Information System (INIS)

    The management of anesthesia used in the plastic reconstruction of 18 cases of radiation injury of neck is reported. 17 cases were malignant tumor patients. After radiotherapy, their general condition was weak. The injury of neck skin and surrounding tissues was severe. Most operations were excision of the focus and repairing the wound using adjacent flap. The choice of anesthesia depended on the general condition, degree of injury and the procedure. Good pre-operative preparation, close monitoring and satisfactory airway control during operation are very important

  18. Cervical spinal cord compression after thyroidectomy under general anesthesia.

    Science.gov (United States)

    Yao, Wenlong; Qiu, Jin; Zhou, Zhiqiang; Zhang, Lin; Zhang, Chuanhan

    2014-02-01

    Cervical spinal cord injury is a rare but serious complication after general anesthesia. The risk factors include traumatic cervical injury, cervical spine instability, and difficult airway management. It has also occurred in the absence of cervical instability. Here we report a patient who had a history of intermittent neck pain without numbness. Preoperative radiologic examinations showed degenerative changes in the cervical spine. She developed progressive tingling and numbness in her limbs after thyroidectomy under general anesthesia. Magnetic resonance imaging showed a cervical disc protruding into the canal at C5-C6, which was considered to be induced by surgical positioning. She recovered after anterior cervical decompression and internal fixation surgery. PMID:23828450

  19. [Analgesia and anesthesia in the prehospital stage of mechanical trauma].

    Science.gov (United States)

    Beliakov, V A; Sinitsyn, L N; Maksimov, G A; Akulov, M S; Kalachev, S A; Medvedskiĭ

    1993-01-01

    The work reviews the results of the use of various analgesics and anesthetics in 965 outpatients with mechanical traumas, including 340 ones with shock and blood loss. Central hemodynamics has been studied in 60 patients during anesthesia with lexir, ketamine, sodium hydroxybutyrate, respiratory function has been assessed in 20 patients. The results have been confirmed experimentally on 160 rats, 50 cats, and 40 dogs. It is recommended to apply narcotic and nonnarcotic analgesics, lexir, ketamine intramuscularly not only to patients with shock and pronounced blood loss in whom infusion therapy and intravenous anesthesia with sodium hydroxybutyrate are necessary but in all other cases as well. PMID:8116897

  20. Accidently Discovered Postpartum Pituitary Apoplexy after Epidural Anesthesia

    Directory of Open Access Journals (Sweden)

    Rafik Sedra

    2014-11-01

    Full Text Available Anesthetic consideration of obstetric patients with pituitary disorders is an important topic to deal with. Few cases were reported with accidently discovered pituitary tumor complications especially in the postpartum period. A 26 years old primigravida lady with 39 weeks gestational period was reported to have severe headache and sudden loss of conscious after normal vaginal delivery with lumbar epidural anesthesia. Accidently discovered pituitary adenoma was proved after neurology, endocrine and ophthalmology consultations. Hence, undiagnosed pituitary adenomas should be taken in to consideration with unexplained postpartum generalized weakness and loss of conscious especially after exclusion of epidural anesthesia complications.

  1. 21 CFR 868.5160 - Gas machine for anesthesia or analgesia.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gas machine for anesthesia or analgesia. 868.5160... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5160 Gas machine for anesthesia or analgesia. (a) Gas machine for anesthesia—(1) Identification. A gas machine for anesthesia is...

  2. Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification

    Directory of Open Access Journals (Sweden)

    Nauman Ahmad

    2012-01-01

    Full Text Available Background: Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Methods: Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS. The Student′s t-test was used to determine the significance of IOWA score in both groups. P<0.05 was considered significant. Results: Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively. In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively. Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Conclusion: Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

  3. Cardiac arrest during spinal anesthesia for cervical conization: a case report.

    Science.gov (United States)

    Shinohara, Satoshi; Sakamoto, Ikuko; Numata, Masahiro; Ikegami, Atsushi; Teramoto, Katsuhiro; Hirata, Shuji

    2016-05-01

    Spinal anesthesia is regularly performed worldwide and is an integral part of the modern day anesthesia practice. Although unexpected cardiac arrests during this procedure are very rare, medical professionals should be aware of the potential for this complication. In making the decision to use spinal anesthesia, judicious patient selection, adequate preventive measures, and strict monitoring are important. PMID:27190608

  4. Effect of anesthesia on glucose production and utilization in rats

    International Nuclear Information System (INIS)

    This study was undertaken to determine the effects of pentobarbital anesthesia (50 mg/kg ip) on glucose kinetics and individual tissue glucose utilization in vivo, in chronically catheterized rats. Glucose turnover studies were carried out using [3-3H] glucose as tracer. A transient hyperglycemia and an increased glucose production were observed 3 min after induction of anesthesia. However, 40 min after induction of anesthesia, glycemia returned to the level observed in awake animals, whereas glucose turnover was decreased by 30% as compared with unanesthetized rats. These results are discussed with regard to the variations observed in plasma insulin, glucagon, and catecholamine levels. Glucose utilization by individual tissues was studied by the 2-[1-3H] deoxyglucose technique. A four- to fivefold decrease in glucose utilization was observed in postural muscles (soleus and adductor longus), while in other nonpostural muscles (epitrochlearis, tibialis anterior, extensor digitorum longus, and diaphragm) and other tissues (white and brown adipose tissues) anesthesia did not modify the rate of glucose utilization. A decrease in glucose utilization was also observed in the brain

  5. Fetal heart rate changes associated with general anesthesia.

    Science.gov (United States)

    Fedorkow, D M; Stewart, T J; Parboosingh, J

    1989-07-01

    Decreased fetal heart rate variability was noted 90 seconds after the induction of general anesthesia with sodium thiopentone and fentanyl in a patient undergoing basket extraction of a renal calculus at 30 weeks' gestation. The fetal sleep pattern lasted for 105 minutes after the anesthetic was discontinued, 45 minutes after the mother was fully awake. PMID:2730732

  6. Creation of an integrated outcome database for pediatric anesthesia.

    Science.gov (United States)

    Cravero, Joseph P; Sriswasdi, Patcharee; Lekowski, Rebecca; Carpino, Elizabeth; Blum, Richard; Askins, Nissa; Zurakowski, David; Sinnott, Sean

    2016-04-01

    Outcome analysis is essential to health care quality improvement efforts. Pediatric anesthesia faces unique challenges in analyzing outcomes. Anesthesia most often involves a one-time point of care interaction where work flow precludes detailed feedback to care givers. In addition, pediatric outcome evaluations must take into account patients' age, development, and underlying illnesses when attempting to establish benchmarks. The deployment of electronic medical records, including preoperative, operative, and postoperative data, offers an opportunity for creating datasets large and inclusive enough to overcome these potential confounders. At our institution, perioperative data exist in five distinct environments. In this study, we describe a method to integrate these datasets into a single web-based relational database that provides researchers and clinicians with regular anesthesia outcome data that can be reviewed on a daily, weekly, or monthly basis. Because of its complexity, the project also entailed the creation of a 'dashboard,' allowing tracking of data trends and rapid feedback of measured metrics to promote and sustain improvements. We present the first use of such a database and dashboard for pediatric anesthesia professionals as well as successfully demonstrating its capabilities to perform as described above. PMID:26956515

  7. Effect of anesthesia on glucose production and utilization in rats

    Energy Technology Data Exchange (ETDEWEB)

    Penicaud, L.; Ferre, P.; Kande, J.; Leturque, A.; Issad, T.; Girard, J.

    1987-03-01

    This study was undertaken to determine the effects of pentobarbital anesthesia (50 mg/kg ip) on glucose kinetics and individual tissue glucose utilization in vivo, in chronically catheterized rats. Glucose turnover studies were carried out using (3-/sup 3/H) glucose as tracer. A transient hyperglycemia and an increased glucose production were observed 3 min after induction of anesthesia. However, 40 min after induction of anesthesia, glycemia returned to the level observed in awake animals, whereas glucose turnover was decreased by 30% as compared with unanesthetized rats. These results are discussed with regard to the variations observed in plasma insulin, glucagon, and catecholamine levels. Glucose utilization by individual tissues was studied by the 2-(1-/sup 3/H) deoxyglucose technique. A four- to fivefold decrease in glucose utilization was observed in postural muscles (soleus and adductor longus), while in other nonpostural muscles (epitrochlearis, tibialis anterior, extensor digitorum longus, and diaphragm) and other tissues (white and brown adipose tissues) anesthesia did not modify the rate of glucose utilization. A decrease in glucose utilization was also observed in the brain.

  8. Review of knee arthroscopy performed under local anesthesia

    Directory of Open Access Journals (Sweden)

    Law Billy

    2009-01-01

    Full Text Available Abstract Local anesthesia for knee arthroscopy is a well documented procedure with diagnostic and therapeutic role. Numerous therapeutic procedures including partial menisectomy, meniscus repair, abrasion chondroplasy, synovectomy, loose body removal can be performed safely and comfortably. Appropriate case selection, anesthetic strategy and technical expertise are the key to smooth and successful surgery.

  9. Inverse zombies, anesthesia awareness, and the hard problem of unconsciousness.

    Science.gov (United States)

    Mashour, George A; LaRock, Eric

    2008-12-01

    Philosophical (p-) zombies are constructs that possess all of the behavioral features and responses of a sentient human being, yet are not conscious. P-zombies are intimately linked to the hard problem of consciousness and have been invoked as arguments against physicalist approaches. But what if we were to invert the characteristics of p-zombies? Such an inverse (i-) zombie would possess all of the behavioral features and responses of an insensate being, yet would nonetheless be conscious. While p-zombies are logically possible but naturally improbable, an approximation of i-zombies actually exists: individuals experiencing what is referred to as "anesthesia awareness." Patients under general anesthesia may be intubated (preventing speech), paralyzed (preventing movement), and narcotized (minimizing response to nociceptive stimuli). Thus, they appear--and typically are--unconscious. In 1-2 cases/1000, however, patients may be aware of intraoperative events, sometimes without any objective indices. Furthermore, a much higher percentage of patients (22% in a recent study) may have the subjective experience of dreaming during general anesthesia. P-zombies confront us with the hard problem of consciousness--how do we explain the presence of qualia? I-zombies present a more practical problem--how do we detect the presence of qualia? The current investigation compares p-zombies to i-zombies and explores the "hard problem" of unconsciousness with a focus on anesthesia awareness. PMID:18635380

  10. Ingestion of a Fixed Partial Denture During General Anesthesia

    OpenAIRE

    Neustein, Steve; Beicke, Mark

    2007-01-01

    Dental trauma during anesthesia is a common occurrence. Many patients have had extensive dental work, which is more fragile than the natural dentition. This work may include crowns, fixed partial dentures (bridges), and porcelain veneers. We report for the first time, a case in which a fixed partial denture became dislodged and was ingested, and was recovered postoperatively with endoscopy.

  11. 76 FR 16796 - Pediatric Anesthesia Safety Initiative (PASI)

    Science.gov (United States)

    2011-03-25

    ... population databases for cognitive developmental effects where exposure to general anesthesia before the age... regarding the effects of anesthetics and sedatives in the pediatric population. The output from PASI will.... Therefore, numerous non-clinical and clinical studies are needed to assess the effect of anesthetics...

  12. Ambulatory anesthesia in plastic surgery: opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Facque AR

    2015-10-01

    Full Text Available Alexander R Facque, Peter J Taub Division of Plastic and Reconstructive Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA Abstract: In 2013, there were 17 million procedures performed by plastic and reconstructive surgeons in the United States in the private office or ambulatory “surgicenter” setting, as well as additional operations performed in hospitals on an outpatient basis. As interest in performing increasingly complex surgical procedures on an outpatient basis continues to grow, the surgeon and anesthesiologist alike must be prepared to offer safe and reliable anesthesia and analgesia in the ambulatory setting. Surgeons must be aware of the possible techniques that will be employed in their surgeries in order to anticipate and prepare patients for possible postoperative side effects, and anesthesiologists must be prepared to offer such techniques in order to ensure a relatively rapid return to normal activity despite potentially having undergone major surgery. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients with comments on recent developments in the techniques used to safely administer agreeable and effective anesthesia. Keywords: ambulatory surgery, cosmetic anesthesia, outpatient, ambulatory anesthesia

  13. Seizure-like activity during fentanyl anesthesia. A case report.

    OpenAIRE

    Webb, M. D.

    1990-01-01

    Fentanyl induced seizures have been described previously in the literature. Clinical observations has labeled the movements seen in fentanyl anesthesia as seizure activity but electroencephalographic studies have not supported this. A case of seizure-like activity after the administration of fentanyl in a 20-year-old female is reported.

  14. Rational use of oxygen in medical disease and anesthesia

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Staehr, Anne K; Rasmussen, Lars S

    2012-01-01

    Supplemental oxygen is often administered during anesthesia and in critical illness to treat hypoxia, but high oxygen concentrations are also given for a number of other reasons such as prevention of surgical site infection (SSI). The decision to use supplemental oxygen is, however, controversial...

  15. The Ryder Cognitive Aid Checklist for Trauma Anesthesia.

    Science.gov (United States)

    Behrens, Vicente; Dudaryk, Roman; Nedeff, Nicholas; Tobin, Joshua M; Varon, Albert J

    2016-05-01

    Despite mixed results regarding the clinical utility of checklists, the anesthesia community is increasingly interested in advancing research around this important topic. Although several checklists have been developed to address routine perioperative care, few checklists in the anesthesia literature specifically target the management of trauma patients. We adapted a recently published "trauma and emergency checklist" for the initial phase of resuscitation and anesthesia of critically ill trauma patients into an applicable perioperative cognitive aid in the form of a pictogram that can be downloaded by the medical community. The Ryder Cognitive Aid Checklist for Trauma Anesthesia is a letter-sized, full-color document consisting of 2 pages and 5 sections. This cognitive aid describes the essential steps to be performed: before patient arrival to the hospital, on patient arrival to the hospital, during the initial assessment and management, during the resuscitation phase, and for postoperative care. A brief online survey is also presented to obtain feedback for improvement of this tool. The variability in utility of cognitive aids may be because of the specific clinical task being performed, the skill level of the individuals using the cognitive aid, overall quality of the cognitive aid, or organizational challenges. Once optimized, future research should be focused at ensuring successful implementation and customization of this tool. PMID:27101496

  16. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

    Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  17. Dexmedetomidine for the prevention of shivering during spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Burhanettin Usta

    2011-01-01

    Full Text Available PURPOSE: The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia. METHODS: Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years, scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30 or dexmedetomidine (group D, n = 30. Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection. RESULTS: Hypothermia was observed in 21 patients (70% in group D and in 20 patients (66.7% in group C (p = 0.781. Three patients (10% in group D and 17 patients (56.7% in group C experienced shivering (p = 0.001. The intensity of shivering was lower in group D than in group C (p = 0.001. Time from baseline to onset of shivering was 10 (5-15 min in group D and 15 (5-45 min in group C (p = 0.207. CONCLUSION: Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.

  18. The development of pediatric anesthesia and intensive care in Scandinavia

    DEFF Research Database (Denmark)

    Nilsson, Krister; Ekström-Jodal, Barbro; Meretoja, Olli;

    2015-01-01

    created. Scandinavian anesthesia developed slowly. In contrast, Scandinavia pioneered both adult and certainly pediatric intensive care. The pioneers were heavily involved in the teaching and training of anesthetists and nurses. This was necessary to manage the rapidly increasing work. The polio epidemics...

  19. Pupil Size in Relation to Cortical States during Isoflurane Anesthesia

    Science.gov (United States)

    Kum, Jeung Eun; Han, Hio-Been

    2016-01-01

    In neuronal recording studies on anesthetized animals, reliable measures for the transitional moment of consciousness are frequently required. Previous findings suggest that pupil fluctuations reflect the neuronal states during quiet wakefulness, whose correlation was unknown for the anesthetized condition. Here, we investigated the pupillary changes under isoflurane anesthesia simultaneously with the electroencephalogram (EEG) and electromyogram (EMG). The pupil was tracked by using a region-based active contour model. The dose was given to the animal in a stepwise increasing mode (simulating induction of anesthesia) or in a stepwise decreasing mode (simulating emergence of anesthesia). We found that the quickly widening pupil action (mydriasis) characterizes the transitional state in anesthesia. Mydriasis occurred only in the light dose in the emergence phase, and the events were accompanied by an increase of burst activity in the EEG followed by EMG activity in 47% of the mydriasis events. Our findings suggest that recording such pupil changes may offer a noncontact monitoring tool for indexing the transitional state of the brain, particularly when a lower threshold dose is applied. PMID:27122995

  20. Cardiorespiratory effects of isoflurane anesthesia in crested caracaras (Caracara plancus).

    Science.gov (United States)

    Escobar, André; Thiesen, Roberto; Vitaliano, Sérgio N; Belmonte, Emílio A; Werther, Karin; Valadão, Carlos A A

    2011-03-01

    To evaluate the cardiorespiratory changes induced by isoflurane (ISO) anesthesia in the crested caracara (Caracara plancus), eight crested caracaras that weighed 1.0 kg (range 0.9-1.1 kg) were the subjects for the study. The birds were anesthetized by face mask with ISO for brachial artery catheterization. After recovery, anesthesia was re-induced and maintained with ISO with spontaneous ventilation. Electrocardiography, direct systolic arterial blood pressure (SAP), diastolic arterial blood pressure (DAP), mean arterial blood pressure (MAP), respiratory rate (RR), end-tidal carbon dioxide (P(ET)CO2), and cloacal temperature (T degrees C) were measured before induction (baseline, under physical restraint) and after 5, 10, 15, 20, 25, 30, 35, and 40 min of ISO anesthesia. Arterial blood samples were collected for blood gas analysis at baseline, 10, 25, and 40 min. No cardiac arrhythmias were observed in the present study. RR, SAP, DAP, MAP, T degrees C and pH decreased from baseline values, whereas arterial partial pressures of oxygen and carbon dioxide, bicarbonate concentration, and P(ET)CO2 were significantly higher than baseline. Apnea was not observed in any bird. ISO anesthesia is suitable for use in healthy members of this species despite the moderate cardiovascular and respiratory depression produced. PMID:22946364

  1. Appropriate practice of anesthesia: A plea for better training

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    O P Adudu

    2011-01-01

    Full Text Available Background: The role of the anesthesiologist is often unknown among patients. But, the situation where the anesthesiologist is uncertain of his/her function gives more cause for concern. Methods: A questionnaire survey on the appraisal of anesthetic practices was carried out over 5 months using the style of clinical practice. Results: One-third of the anesthesiologists who responded to the survey attached little importance to the work they did by not communicating the same to their patients while 45.2% did not discuss the intraoperative findings with the surgeons. Although 57 (59.4% of the respondents usually visit their patients on the ward preoperatively, only 16 (21.6% discussed the proposed anesthetic procedure with the patients. Thirty-nine (40.2% respondents claimed that they do not wear ward coats to the ward at the preoperative visit. Less than 20% consistently conducted a postoperative visit. The majority of the respondents would treat all patients as important, irrespective of social status, while 74.5% of them considered obtaining informed consent for anesthesia from patients as significantly important. Conclusion: The current practice of anesthesia has been found wanting in several aspects. Knowledgeable discussion by anesthesiologists with surgeons as well as enlightenment of patients and their relatives about their work will improve the quality of anesthesia care remarkably. Changes in the anesthesia training curriculum to reflect these deficiencies would be helpful.

  2. Anesthesia for off-pump coronary artery bypass surgery

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    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  3. Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy

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    Poonam S Ghodki

    2014-01-01

    Full Text Available Context: Spinal anesthesia (SA was combined with general anesthesia (GA for achieving hemodynamic stability in laparoscopic hysterectomy. Aims: The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile. Settings and Design: We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study. Materials and Methods: Patients were randomly assigned to receive SA with GA (group SGA or plain GA (group GA. Group SGA received 10 mg bupivacaine (heavy for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied. Statistical analysis used: Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR, mean arterial pressure (MAP, SPO2, and etCO2 was done with Student′s t-test or Mann-Whitney test, wherever applicable. Results: Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01. Group GA showed additional requirement of metoprolol (53.33% and higher concentration of isoflurane (P < 0.001 to combat the increased MAP. Recovery was early and quick in group SGA as

  4. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

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    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  5. Assessment of current undergraduate anesthesia course in a Saudi University

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    Tarek Shams

    2013-01-01

    Full Text Available Background: The assessment of the anesthesia course in our university comprises Objective Structured Clinical Examinations (OSCEs, in conjunction with portfolio and multiple-choice questions (MCQ. The objective of this study was to evaluate the outcome of different forms of anesthesia course assessment among 5 th year medical students in our university, as well as study the influence of gender on student performance in anesthesia. Methods: We examined the performance of 154, 5 th year medical students through OSCE, portfolios, and MCQ. Results: The score ranges in the portfolio, OSCE, and MCQs were 16-24, 4.2-28.9, and 15.5-44.5, respectively. There was highly significant difference in scores in relation to gender in all assessments other than the written one (P=0.000 for Portfolio, OSCE, and Total exam, whereas P=0.164 for written exam. In the generated linear regression model, OSCE alone could predict 86.4% of the total mark if used alone. In addition, if the score of the written examination is added, OSCE will drop to 57.2% and the written exam will be 56.8% of the total mark. Conclusions: This study demonstrates that different clinical methods used to assess medical students during their anesthesia course were consistent and integrated. The performance of female was superior to male in OSCE and portfolio. This information is the basis for improving educational and assessment standards in anesthesiology and for introducing a platform for developing modern learning media in countries with dearth of anesthesia personnel.

  6. The effect of anesthesia on the radiographic appearance of the coxofemoral joints

    International Nuclear Information System (INIS)

    The effect of anesthesia on the radiographic appearance of the coxofemoral joints was evaluated by taking pelvic radiographs of thirty dogs. Each dog was radiographed twice, once under general anesthesia and once without anesthesia. The radiographs were submitted to the Orthopedic Foundation for Animals independently of one another to be evaluated for signs of hip dysplasia. Results suggest there was no statistical difference between the two groups of dogs. Twenty five dogs received the same reading. Three dogs received readings that were worse by one grade while under anesthesia and two dogs received readings that were one grade better while under anesthesia. This study failed to demonstrate any changes due to anesthesia on the radiographic appearance of the coxofemoral joints. Anesthesia may, however, be beneficial for proper positioning and to decrease unnecessary patient, and personnel exposure to radiation

  7. PERI-ANESTHESIA ANAPHYLAXIS (PAA): WE STILL HAVE NOT STARTED POST-PAA TESTING FOR INCITING ANESTHESIA-RELATED ALLERGENS.

    Science.gov (United States)

    Alshaeri, Taghreed; Gupta, Deepak; Nagabhushana, Ananthamurthy

    2016-02-01

    Anaphylaxis during anesthesia is uncommon. Diagnosis of peri-anesthesia anaphylaxis (PAA) requires anesthesia providers' vigilance for prompt diagnosis and treatment. In this case report, we present a challenging case with suspected PAA including its perioperative management, intensive care unit (ICU) course, and post-discharge follow-up. A 44-year-old female (body mass index = 26) presented for elective abdominal panniculectomy. Post-intubation, severe bronchospasm occurred that was non-responsive to nebulized albuterol and intravenous epinephrine. Continuous infusion of epinephrine was initiated. After aborting surgical procedure, the patient was transferred to ICU on continuous intravenous infusion of epinephrine. Venous blood sampling showed elevated troponin level. Echocardiography revealed ejection fraction of 25% suspicious of Takotsubo cardiomyopathy (mid cavitary variant). Tracheal extubation was only possible after three days. Subsequently, patient was discharged home with a cardiology follow-up appointment and a referral to an allergy specialist. Unfortunately at our institution (an academic university hospital in United States) along with neighboring institutions in near-by areas, the only allergy skin tests available are for local anesthetics and antibiotics, while neuromuscular blocking agents (NMBAs) cannot be tested (the suspected anaphylactic agent in our case was presumably rocuronium). In summary, PAA requires and responds to emergent diagnosis and immediate treatment; however there is still a long way to go to ensure post-PAA testing for inciting anesthesia-related allergens. PMID:27382817

  8. Guidelines for administration of local anesthesia for dermatosurgery and cosmetic dermatology procedures

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    Mysore Venkataram

    2009-08-01

    Full Text Available Introduction, definition, rationale and scope: Dermatosurgery and Cosmetic dermatology procedures are being performed by increasing number of dermatologists. Most dermatosurgeries are performed in an outpatient setting and as day care surgeries, under local anesthesia. Hence, it is important to improve patient comfort during all procedures. These guidelines seek to lay down directives in the use of local anesthesia, outline the different local anesthetics, the mode of administration, complications arising out of such procedure and management of the same. Facility for administration of local anesthesia: Local anesthesia is usually administered in the dermatologist′s procedure room. The room should be equipped to deal with any emergencies arising from administration of local anesthesia. Qualifications of local anesthesia administrator: Local anesthesia administrator is a person who applies or injects local anesthetic agent for causing analgesia. Procedures done under local anesthesia are classified as Level I office procedures and require the administrator to have completed a course in Basic Cardiac Life Support (BCLS. Evaluation of patients for topical or infiltrative anesthesia: Details of patient′s past medical history and history of medications should be noted. Allergy to any medications should be specifically enquired and documented. Patients for tumescent anesthesia need additional precautions to be observed as described in these guidelines. Methods of administration of local anesthesia: Different methods include topical anesthesia, field block, ring block, local infiltration and nerve block. Also, it includes use of local anesthetics for anesthetizing oral and genital mucosa. Tumescent anesthesia is a special form of local anesthesia used in liposuction and certain selected procedures. Local anesthetic agents: Different local anesthetics are available such as lignocaine, prilocaine, bupivacaine. The dermatologist should be aware of the

  9. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery

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    Seyyed Mostafa Moosavi Tekye

    2014-06-01

    Full Text Available Introduction: A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes. This prospective randomized study compared unilateral and bilateral spinal anesthesia with respect to the intra- and postoperative advantages and complications of each technique. Material and methods: Spinal anesthesia was induced with 0.5% hyperbaric bupivacaine and a 25-G Quincke needle (Dr. J in two groups of patients with physical status ASA I-II who had been admitted for orthopedic surgeries. In group A, dural puncture was performed with the patient in a seated position using 2.5 cm3 of hyperbaric bupivacaine. Each patient was then placed in the supine position. In group B, dural puncture was performed with the patient in the lateral decubitus position with 1.5 cm3 of hyperbaric bupivacaine. The lower limb was the target limb. The speed of injection was 1 mL/30 s, and the duration of time spent in the lateral decubitus position was 20 min. Results: The demographic data were similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group A (p = 0.00. The duration of motor and sensory block was shorter in group B (p < 0.05. The success rate for unilateral spinal anesthesia in group B was 94.45%. In two patients, the spinal block spread to the non-dependent side. The incidence of complications (nausea, headache, and hypotension was lower in group B (p = 0.02. Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during orthopedic surgery on a lower limb. Patients were more satisfied with this technique as opposed to the conventional approach. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.

  10. Effect Halothane-Induced Anesthesia on Plasma Cortisol in Celiotomy in Pigeon

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    S. Sabiza

    2012-08-01

    Full Text Available Blood biochemical factors are changed by anesthesia in birds. Cortisol is one of these factors which related to inflammation and pain at surgery or post-operation. In present study, we evaluated effect of halothaneinduced anesthesia on plasma level of cortisol in pigeon. Ten domestic pigeons were used. The weight of birds was about 300 g. After 3 to 4 h food restriction, anesthesia was induced by halothane for celiotomy within 20 min. Anesthesia was induced by halothane at 2.5% with oxygen gas and it continued by 1.5% halothane. Blood sample was collected before, during and after surgery from pigeons and plasma level of cortisol was measured by commercial kit. Anesthesia induction and maintenance with halothane provided suitable anesthesia during celiotomy in pigeon. Plasma level of cortisol was significantly decreased after anesthesia. The mean of cortisol was 2.02 ng/mL before anesthesia and reached to 1.75 and 1.59 ng/mL in during and after anesthesia respectively. This change significantly differed with comparison to before surgery. But the mean of cortisol was not different significantly between duration of surgery and post operation. Halothane can decrease level of cortisol during anesthesia and so it decreases anti-inflammatory and analgesic effect of cortisol and also side effect of corticostroids.

  11. Anesthesia-related critical incidents in the perioperative period in children : A proposal for an anesthesia-related reporting system for critical incidents in children

    NARCIS (Netherlands)

    De Graaff, Jurgen C.; Sarfo, Marie Christine; Van Wolfswinkel, Leo; van der Werff, Desiree B. M.; Schouten, Antonius N J

    2015-01-01

    Background The incidence, type and severity of anesthesia-related critical incidents during the perioperative phase has been investigated less in children than in adults. Aim The aim of the study was to identify and analyze anesthesia-related critical incidents in children to identify areas to impro

  12. The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients

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    Dilsen Ornek

    2010-01-01

    Full Text Available OBJECTIVE: We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast-track eligibility in day surgeries. MATERIALS AND METHOD: Sixty geriatric outpatient cases, with ASA II-III physical status and requiring shortduration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA and selective spinal anesthesia (Group SSA. Group GA (n = 30 received propofol 2 mg kg-1 (until loss of eyelash reflex, remifentanil induction 0.5-1 µg kg-1, and laryngeal mask. Maintenance was achieved by 4-6% desflurane in 60% N2O and 40% O2 along with remifentanil infusion at 0.05 µg /kg-1 /min-1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O2. Group SSA (n = 30 received 0.5% spinal anesthesia via L4-5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast-tracking, and time to White-Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam-fentanyl administration, postoperative pain, and discharge time. RESULTS: Anesthesia preparation time, length of surgery, anesthesia-related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p < 0.05, whereas time to fast-track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups. CONCLUSION: While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast-track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.

  13. Nerves and Anesthesia: A physics perspective on medicine

    CERN Document Server

    Heimburg, Thomas

    2014-01-01

    We present a recent theory for nerve pulse propagation and anesthesia and argue that both nerve activity and the action of anesthetics can be understood on the basis of simple physical laws. It was found experimentally that biological membranes melt from a solid state to a liquid state just below physiological temperature. Such melting processes have a profound influence on the physical properties of cell membranes. They make it possible for mechanical pulses (solitons) to travel along nerve axons. In these pulses, a region of solid phase travels in the liquid nerve membrane. These pulses display many properties associated with the action potential in nerves. Both general and local anesthetics lower melting temperatures of membranes. Thus, they make it more difficult to excite the nerve membrane. Since hydrostatic pressure increases melting temperatures, it counteracts anesthesia. This theory has the virtue of providing a simple explanation of the famous Meyer-Overton correlation, which states that the effect...

  14. Monitored anesthesia care (MAC sedation: clinical utility of fospropofol

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    Eric A Harris

    2009-12-01

    Full Text Available Eric A Harris, David A Lubarsky, Keith A CandiottiDepartment of Anesthesiology, Perioperative Management, and Pain Medicine, University of Miami/Miller School of MedicineAbstract: Fospropofol, a phosphorylated prodrug version of the popular induction agent propofol, is hydrolyzed in vivo to release active propofol, formaldehyde, and phosphate. Pharmacodynamic studies show fospropofol provides clinically useful sedation and EEG/bispectral index suppression while causing significantly less respiratory depression than propofol. Pain at the injection site, a common complaint with propofol, was not reported with fospropofol; the major patient complaint was transitory perianal itching during the drug’s administration. Although many clinicians believe fospropofol can safely be given by a registered nurse, the FDA mandated that fospropofol, like propofol, must be used only in the presence of a trained anesthesia provider.Keywords: fospropofol, propofol, monitored anesthesia care

  15. Medication error report: Intrathecal administration of labetalol during obstetric anesthesia

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    Baisakhi Laha

    2015-01-01

    Full Text Available Labetalol, a combined alfa and beta-adrenergic receptor antagonist, is used as an antihypertensive drug. We report a case of an acute rise in blood pressure and lower limb pain due to the inadvertent intrathecal administration of labetalol, mistaking it for bupivacaine, during obstetric anesthesia. The situation was rescued by converting to general anesthesia. The cesarean delivery was uneventful, and mother as well as newborn child showed no ill-effect. This particular medication error was attributable to a failure on the part of the doctors administering the injection to read and cross-check medication labels and the practice of keeping multiple injections together. In the absence of an organized medication error reporting system and action on that basis, such events may recur in future.

  16. Regional anesthesia in patients with pregnancy induced hypertension

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    Saravanan P Ankichetty

    2013-01-01

    Full Text Available Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.

  17. Issues of critical airway management (Which anesthesia; which surgical airway?

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    Fabrizio Giuseppe Bonanno

    2012-01-01

    Full Text Available Which anesthesia for patients with critical airway? Safe and effective analgesia and anesthesia in critical airway is a skilled task especially after severe maxillofacial injury combined with head injury and hemorrhagic shock. If on one side sedation is wanted, on the other hand it may worsen the airway and hemodynamic situation to a point where hypoventilation and decrease of blood pressure, common side-effect of many opioids, may prejudice the patient′s level of consciousness and hemodynamic compensation, compounding an already critical situation. What to do when endotracheal intubation fails and blood is trickling down the airways in an unconscious patient or when a conscious patient has to sit up to breathe? Which surgical airway in critical airway? Comparative studies among the various methods of emergency surgical airway would be unethical; furthermore, operator′s training and experience is relevant for indications and performance.

  18. Issues of critical airway management (Which anesthesia; which surgical airway?).

    Science.gov (United States)

    Bonanno, Fabrizio Giuseppe

    2012-10-01

    Which anesthesia for patients with critical airway? Safe and effective analgesia and anesthesia in critical airway is a skilled task especially after severe maxillofacial injury combined with head injury and hemorrhagic shock. If on one side sedation is wanted, on the other hand it may worsen the airway and hemodynamic situation to a point where hypoventilation and decrease of blood pressure, common side-effect of many opioids, may prejudice the patient's level of consciousness and hemodynamic compensation, compounding an already critical situation. What to do when endotracheal intubation fails and blood is trickling down the airways in an unconscious patient or when a conscious patient has to sit up to breathe? Which surgical airway in critical airway? Comparative studies among the various methods of emergency surgical airway would be unethical; furthermore, operator's training and experience is relevant for indications and performance. PMID:23248494

  19. [Risk management in anesthesia and critical care medicine].

    Science.gov (United States)

    Eisold, C; Heller, A R

    2016-06-01

    Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems. PMID:27273109

  20. An update on local anesthesia for pediatric dental patients

    OpenAIRE

    Faizal C. Peedikayil; Vijayan, Ajoy

    2013-01-01

    Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients.

  1. Sonographic guidance for infant hip reduction under anesthesia

    International Nuclear Information System (INIS)

    An initial attempt to reduce a hip dislocation in a 15-month-old by palpation under general anesthesia led to the subsequent discovery of a posterior subluxation by CT. During the second attempt, sonographic guidance in the operating room was used to show concentric reduction both before and after the application of a spica cast. Successful reduction was later confirmed by CT. Imaging by real-time sonography can be useful in monitoring infant hip reduction. (orig.)

  2. Iliosacral Screw Placement With Local Anesthesia Using C T Scan

    Directory of Open Access Journals (Sweden)

    Shahriar Kamrani R

    2003-07-01

    Full Text Available Ilio-sacral screw is a technique for posterior pelvic fixation. In spite of its benefits, it had not performed commonly in Iran because of its difficulties. We changed this technique to insert the screw under CT-Scan guide with lical anesthesia to increase image quality and decrease neurological complications and performed it in two patients. In both cases the screws were inserted in correct position without any complication."n"n 

  3. Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia.

    Science.gov (United States)

    Schaefer, Michael

    2009-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) has recently evolved as a novel approach for abdominal surgery with great potential to further improve the advantages of laparoscopy over laparotomy. The first patients undergoing NOTES cholecystectomy or appendectomy reported no or only minimal pain, required no narcotic analgesics, and were discharged early from the hospital and immediately resumed daily activities. If this is confirmed by randomized controlled clinical trials, what are the potential implications for anesthesia? PMID:20948698

  4. Combination of spinal anesthesia and peripheral nerve block: Case report

    OpenAIRE

    Vildan Temel; Sedat Kaya; Gönül Ölmez Kavak; Haktan Karaman; Adnan Tüfek; Feyzi Çelik

    2010-01-01

    Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic dis...

  5. Is Hydrogen Sulfide-Induced Suspended Animation General Anesthesia?

    OpenAIRE

    Li, Rosie Q.; McKinstry, Andrew R.; Moore, Jason T.; Caltagarone, Breanna M.; Eckenhoff, Maryellen F.; Eckenhoff, Roderic G.; Kelz, Max B.

    2012-01-01

    Hydrogen sulfide (H2S) depresses mitochondrial function and thereby metabolic rates in mice, purportedly resulting in a state of “suspended animation.” Volatile anesthetics also depress mitochondrial function, an effect that may contribute to their anesthetic properties. In this study, we ask whether H2S has general anesthetic properties, and by extension, whether mitochondrial effects underlie the state of anesthesia. We compared loss of righting reflex, electroencephalography, and electromy...

  6. Combination of spinal anesthesia and peripheral nerve block: Case report

    OpenAIRE

    Çelik, Feyzi; Tüfek, Adnan; Temel, Vildan; Karaman, Haktan; Kaya, Sedat; Kavak, Gönül Ölmez

    2010-01-01

    Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not af­fect respiratory function. In recent years, regional anaes­thesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patient...

  7. Effects of epidural lidocaine anesthesia on bulls during electroejaculation.

    OpenAIRE

    Falk, A J; Waldner, C L; Cotter, B S; Gudmundson, J.; Barth, A D

    2001-01-01

    Two experiments were conducted to determine whether caudal epidural lidocaine anesthesia reduces a stress response to electroejaculation. In the 1st experiment, changes in cortisol and progesterone concentrations in serial blood samples were used to assess the stress response to restraint (control), transrectal massage, caudal epidural injection of saline, electroejaculation after caudal epidural injection of lidocaine, and electroejaculation without epidural lidocaine. In the 2nd experiment,...

  8. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    OpenAIRE

    Wong, Jean; Shah, Ushma; Wong, David

    2015-01-01

    Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA). Patient satisfaction is a complex concep...

  9. Induced hypotension during anesthesia, with special reference to orthognathic surgery

    OpenAIRE

    Rodrigo, C.

    1995-01-01

    Since Gardner first used arteriotomy during anesthesia to improve visibility in the surgical field, various techniques and pharmacological agents have been tried for the same purpose. With reports documenting the spread of acquired immune deficiency syndrome through blood transfusions, prevention of homologous blood transfusions during surgery has also become a major concern. Induced hypotension has been used to reduce blood loss and thereby address both issues. In orthognathic surgery, induc...

  10. The Mesoscopic Modeling of Burst Suppression during Anesthesia

    OpenAIRE

    Liley, David T. J.; Walsh, Matthew

    2013-01-01

    The burst-suppression pattern is well recognized as a distinct feature of the mammalian electroencephalogram (EEG) waveform. Consisting of alternating periods of high amplitude oscillatory and isoelectric activity, it can be induced in health by deep anesthesia as well as being evoked by a range of pathophysiological processes that include coma and anoxia. While the electroencephalographic phenomenon and clinical implications of burst suppression have been studied extensively, the physiologic...

  11. Propofol Anesthesia and Sleep: A High-Density EEG Study

    Science.gov (United States)

    Murphy, Michael; Bruno, Marie-Aurelie; Riedner, Brady A.; Boveroux, Pierre; Noirhomme, Quentin; Landsness, Eric C.; Brichant, Jean-Francois; Phillips, Christophe; Massimini, Marcello; Laureys, Steven; Tononi, Giulio; Boly, Melanie

    2011-01-01

    Study Objectives: The electrophysiological correlates of anesthetic sedation remain poorly understood. We used high-density electroencephalography (hd-EEG) and source modeling to investigate the cortical processes underlying propofol anesthesia and compare them to sleep. Design: 256-channel EEG recordings in humans during propofol anesthesia. Setting: Hospital operating room. Patients or Participants: 8 healthy subjects (4 males) Interventions: N/A Measurements and Results: Initially, propofol induced increases in EEG power from 12–25 Hz. Loss of consciousness (LOC) was accompanied by the appearance of EEG slow waves that resembled the slow waves of NREM sleep. We compared slow waves in propofol to slow waves recorded during natural sleep and found that both populations of waves share similar cortical origins and preferentially propagate along the mesial components of the default network. However, propofol slow waves were spatially blurred compared to sleep slow waves and failed to effectively entrain spindle activity. Propofol also caused an increase in gamma (25–40 Hz) power that persisted throughout LOC. Source modeling analysis showed that this increase in gamma power originated from the anterior and posterior cingulate cortices. During LOC, we found increased gamma functional connectivity between these regions compared to the wakefulness. Conclusions: Propofol anesthesia is a sleep-like state and slow waves are associated with diminished consciousness even in the presence of high gamma activity. Citation: Murphy M; Bruno MA; Riedner BA; Boveroux P; Noirhomme Q; Landsness EC; Brichant JF; Phillips C; Massimini M; Laureys S; Tononi G; Boly M. Propofol anesthesia and sleep: a high-density EEG study. SLEEP 2011;34(3):283-291. PMID:21358845

  12. Postoperative rhabdomyolysis following pars-plana vitrectomy under general anesthesia

    OpenAIRE

    Campbell JP; Soelberg C; Lauer AK

    2013-01-01

    John P Campbell,1 Cobin Soelberg,2 Andreas K Lauer11Retina Division, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 2Division of Anesthesiology, Oregon Health and Science University, Portland, OR, USAImportance: Rhabdomyolysis is a known, but rare, complication of general anesthesia. To the authors' knowledge, it has never before been reported following an ocular surgery, and we could find no similar cases in the surgical literature following any brief surgi...

  13. Postoperative rhabdomyolysis following pars-plana vitrectomy under general anesthesia

    OpenAIRE

    Campbell, Peter

    2013-01-01

    John P Campbell,1 Cobin Soelberg,2 Andreas K Lauer11Retina Division, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 2Division of Anesthesiology, Oregon Health and Science University, Portland, OR, USAImportance: Rhabdomyolysis is a known, but rare, complication of general anesthesia. To the authors' knowledge, it has never before been reported following an ocular surgery, and we could find no similar cases in the surgical literature following any brief s...

  14. Postoperative rhabdomyolysis following pars-plana vitrectomy under general anesthesia

    Directory of Open Access Journals (Sweden)

    Campbell JP

    2013-08-01

    Full Text Available John P Campbell,1 Cobin Soelberg,2 Andreas K Lauer11Retina Division, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 2Division of Anesthesiology, Oregon Health and Science University, Portland, OR, USAImportance: Rhabdomyolysis is a known, but rare, complication of general anesthesia. To the authors' knowledge, it has never before been reported following an ocular surgery, and we could find no similar cases in the surgical literature following any brief surgical procedure. We believe this case to be unique in those regards and aim to raise awareness among ophthalmologists of this postoperative complication, as timely intervention can prevent renal failure and death.Observations: We report the case of a 58-year-old male who developed rhabdomyolysis following vitrectomy for retinal detachment repair under general anesthesia. The patient had several risk factors for this complication including morbid obesity, type II diabetes mellitus, and American Society of Anesthesia class III risk profile. His postoperative course was notable for significant myalgias in the postoperative recovery area, followed several hours later by oliguria, "root beer" colored urine, and a markedly elevated creatinine kinase level. He was hospitalized for two days for intravenous hydration and monitoring of his renal function and has fully recovered.Relevance: As the prevalence of obesity and type II diabetes mellitus increase worldwide, ophthalmologists need to be aware of the signs and symptoms of postoperative rhabdomyolysis. Treatment often requires inpatient hospitalization to prevent the associated morbidity and mortality.Keywords: rhabdomyolysis, general anesthesia, vitrectomy, retinal detachment, obesity, diabetes

  15. Smart marketing may improve public understanding of the anesthesia profession

    OpenAIRE

    Cohen, Barak; Ogorek, Daniel; Oifa, Stanislav; Cattan, Anat; Matot, Idit

    2015-01-01

    Background A 2005 survey led by the Israeli Society of Anesthesiologists (ISA) found that large parts of the Israeli public are not familiar with the profession of anesthesia. The ISA has subsequently been conducting a public campaign for several years with the aim to enhance community knowledge regarding the anesthesiologists’ training and their critical role in the perioperative period. Objective The present study sought to evaluate the value of a campaign aiming to enhance public understan...

  16. Anecdotes from the history of anesthesia in dentistry.

    OpenAIRE

    Trieger, N.

    1995-01-01

    I believe that dentists have made important contributions to anesthesiology and patient care. Medical anesthesiology is now being required to provide more same-day or ambulatory care. Where it was once good sport to criticize dentists providing brief anesthesia services for their patients, it has now become appropriate for physician anesthesiologists to use shorter-acting agents, improved physiologic monitoring, reversal agents, and early discharge as part of their care of patients. Anecdotes...

  17. Suspected Anesthesia Associated Esophageal Stricture Formation in a Cat

    OpenAIRE

    GÜLTİKEN, Nilgün; PEKMEZCİ, Didem; Ay, Serhan Serhat; KOLDAŞ, Ece; Gram, Aykut

    2014-01-01

    The case of esophageal stricture of a one-year-old queen that occurred after three anesthesia applications (one for ovariohysterectomy and the others for incisional wound complications) in two weeks was presented. Barium contrast esophagography provided the diagnosis of esophageal stricture located at the distal of thoracic esophagus, at the level of intercostal distance of 9-10 in mediastinum caudale. Feeding with canned food placed on a higher surface was recommended in order to prevent reg...

  18. Asystole during pulmonary artery catheter insertion under general anesthesia

    Directory of Open Access Journals (Sweden)

    Swapna Chaudhuri

    2012-01-01

    Full Text Available In spite of ongoing debate for the past 40 years, pulmonary artery catheters remain in use for invasive hemodynamic monitoring and management of critically ill patients. We describe a case of a sudden onset of asystolic cardiac arrest during the placement of a pulmonary artery catheter, while under general anesthesia. A brief review of the literature highlighting arrhythmic complications associated with pulmonary artery catheterization is also presented.

  19. Topical Anesthesia for Cataract Surgery: The Patients' Perspective

    OpenAIRE

    Aytekin Apil; Baki Kartal; Metin Ekinci; Halil Huseyin Cagatay; Sadullah Keles; Erdinc Ceylan; Ozgur Cakici

    2014-01-01

    Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean st...

  20. Acupuncture: History from the Yellow Emperor to Modern Anesthesia Practice.

    Science.gov (United States)

    Faircloth, Amanda

    2015-08-01

    Acupuncture and acupressure are components of Oriental medicine that have been in existence for thousands of years. These practices have transcended from Asia into Western culture. In the context of anesthesia practice, acupuncture and acupressure have demonstrated clinical usefulness in the perioperative setting. Acupuncture and acupressure can successfully decrease preoperative anxiety, decrease intraoperative anesthetic requirements, assuage postoperative pain, decrease the incidence of postoperative nausea and vomiting, and support chronic pain management. PMID:26390748

  1. The effect of hypernatremic state on anesthesia: male Wistar rat

    OpenAIRE

    Heydarpour F, Rostami A, Alipour M, Amini B, Heydarpour P

    2008-01-01

    "nBackground: The function of internal systems can be influenced significantly by hypernatremia, even anesthesia may be affected by this electrolyte imbalance. The aim of this study was to determine the effects of a single anesthetic dose of ketamine in an experimental rat model of chronic hypernatremia. "n"nMethods: Sixty male Wistar rats, weighing 300(±20)g, were allocated randomly to three groups: the control group received drinking water and test groups 1 and 2 r...

  2. Accidently Discovered Postpartum Pituitary Apoplexy after Epidural Anesthesia

    OpenAIRE

    Rafik Sedra

    2014-01-01

    Anesthetic consideration of obstetric patients with pituitary disorders is an important topic to deal with. Few cases were reported with accidently discovered pituitary tumor complications especially in the postpartum period. A 26 years old primigravida lady with 39 weeks gestational period was reported to have severe headache and sudden loss of conscious after normal vaginal delivery with lumbar epidural anesthesia. Accidently discovered pituitary adenoma was proved after neurology, endocrin...

  3. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI)

    OpenAIRE

    Mayr, N. Patrick; Michel, Jonathan; Bleiziffer, Sabine; Tassani, Peter; Martin, Klaus

    2015-01-01

    Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to “intermediate-risk” patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; r...

  4. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI).

    Science.gov (United States)

    Mayr, N Patrick; Michel, Jonathan; Bleiziffer, Sabine; Tassani, Peter; Martin, Klaus

    2015-09-01

    Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to "intermediate-risk" patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; reduced procedure time, shorter intensive care unit (ICU) length of stay, reduced need for intraprocedural vasopressor support, and the potential to perform the procedure without the direct presence of an anesthetist for cost-saving reasons. To date, no randomized trial data exists. We reviewed 13 non-randomized studies/registries reporting data from 6,718 patients undergoing TAVI (3,227 performed under sedation). Patient selection, study methods, and endpoints have differed considerably between published studies. Reported rates of in-hospital and longer-term mortality are similar for both groups. Up to 17% of patients undergoing TAVI-S require conversion to general anesthesia during the procedure, primarily due to vascular complications, and urgent intubation is frequently associated with hemodynamic instability. Procedure related factors, including hypotension, may compound preexisting age-specific renal impairment and enhance the risk of acute kidney injury. Hypotonia of the hypopharyngeal muscles in elderly patients, intraprocedural hypercarbia, and certain anesthetic drugs, may increase the aspiration risk in sedated patients. General anesthesia and conscious sedation have both been used successfully to treat patients with severe AS undergoing TAVI with similar reported short and long-term mortality outcomes. The authors believe that the significant incidence of complications and unplanned conversion to general anesthesia during TAVI-S mandates the start-to-finish presence

  5. A Reminder to Anesthesiologists: Low-Flow Anesthesia

    Directory of Open Access Journals (Sweden)

    Yeliz Kilic

    2014-12-01

    Full Text Available Gas flows less than 1 L/min are defined as low-flow anesthesia. Although most of modern anaesthesia machines are equipped with circle re-breathing systems that can allow to use low fresh-gas flows, relatively high-flow techniques traditionally remain as the primary anaesthetic method. Several factors such as traditional anesthetic habits, insufficient training in the use of these techniques during the residency, and concerns on providing a desirable anesthetic depth limited its widespread use. However, it has many benefits, including decrease in use of inhalational anaesthetics, improvement of body temperature and humidity homeostasis, reduce in environmental pollution, and significant economical advantages. Low-flow anesthesia also carries some concerns such as increased hypoxia risk, potential for gas volume deficiency, misdosage of volatile agents, exhaustion of the absorbent, and accumulation of unwanted gases. Although this technique has some disadvantages, it has become a safe anaesthetic method with using modern anesthesia machines and new-generation anesthetic agents. The aim of this brief report is to describe the low-flow techniques, to indicate the benefits and potential risks, and to attract the attention of anesthesiologists on this important issue.

  6. An essential role for orexins in emergence from general anesthesia

    Science.gov (United States)

    Kelz, Max B.; Sun, Yi; Chen, Jingqiu; Cheng Meng, Qing; Moore, Jason T.; Veasey, Sigrid C.; Dixon, Shelley; Thornton, Marcus; Funato, Hiromasa; Yanagisawa, Masashi

    2008-01-01

    The neural mechanisms through which the state of anesthesia arises and dissipates remain unknown. One common belief is that emergence from anesthesia is the inverse process of induction, brought about by elimination of anesthetic drugs from their CNS site(s) of action. Anesthetic-induced unconsciousness may result from specific interactions of anesthetics with the neural circuits regulating sleep and wakefulness. Orexinergic agonists and antagonists have the potential to alter the stability of the anesthetized state. In this report, we refine the role of the endogenous orexin system in impacting emergence from, but not entry into the anesthetized state, and in doing so, we distinguish mechanisms of induction from those of emergence. We demonstrate that isoflurane and sevoflurane, two commonly used general anesthetics, inhibit c-Fos expression in orexinergic but not adjacent melanin-concentrating hormone (MCH) neurons; suggesting that wake-active orexinergic neurons are inhibited by these anesthetics. Genetic ablation of orexinergic neurons, which causes acquired murine narcolepsy, delays emergence from anesthesia, without changing anesthetic induction. Pharmacologic studies with a selective orexin-1 receptor antagonist confirm a specific orexin effect on anesthetic emergence without an associated change in induction. We conclude that there are important differences in the neural substrates mediating induction and emergence. These findings support the concept that emergence depends, in part, on recruitment and stabilization of wake-active regions of brain. PMID:18195361

  7. ROLE OF DEXMEDETOMIDINE IN ANESTHESIA AND CRITICAL CARE

    Directory of Open Access Journals (Sweden)

    Baljit Singh

    2014-09-01

    Full Text Available The potential uses of dexmedetomidine (DEX, a highly selective α2- adrenoceptor agonist are very diverse Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable; hence it has found a place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high- risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to manage morbidly obese patients and patients with a compromised airway; without causing any cardiorespiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Availability of an antidote (Atipamezole with similar elimination half-life is taking the drug into new frontiers .The aim of this review is to present the most recent topics regarding the advantages in using dexmedetomidine in clinical anesthesia and in critical care, while discussing the controversial issues of its harmful effects.

  8. Paperless anesthesia: uses and abuses of these data.

    Science.gov (United States)

    Anderson, Brian J; Merry, Alan F

    2015-12-01

    Demonstrably accurate records facilitate clinical decision making, improve patient safety, provide better defense against frivolous lawsuits, and enable better medical policy decisions. Anesthesia Information Management Systems (AIMS) have the potential to improve on the accuracy and reliability of handwritten records. Interfaces with electronic recording systems within the hospital or wider community allow correlation of anesthesia relevant data with biochemistry laboratory results, billing sections, radiological units, pharmacy, earlier patient records, and other systems. Electronic storage of large and accurate datasets has lent itself to quality assurance, enhancement of patient safety, research, cost containment, scheduling, anesthesia training initiatives, and has even stimulated organizational change. The time for record making may be increased by AIMS, but in some cases has been reduced. The question of impact on vigilance is not entirely settled, but substantial negative effects seem to be unlikely. The usefulness of these large databases depends on the accuracy of data and they may be incorrect or incomplete. Consequent biases are threats to the validity of research results. Data mining of biomedical databases makes it easier for individuals with political, social, or economic agendas to generate misleading research findings for the purpose of manipulating public opinion and swaying policymakers. There remains a fear that accessibility of data may have undesirable regulatory or legal consequences. Increasing regulation of treatment options during the perioperative period through regulated policies could reduce autonomy for clinicians. These fears are as yet unsubstantiated. PMID:26432199

  9. [Low-flow xenon anesthesia in surgical patients with hypertension].

    Science.gov (United States)

    Rashchupkin, A B; Burov, N E

    2011-01-01

    A comparative study of central hemodynamics in 60 patients with essential hypertension during low flow anesthesia with xenon and nitrous oxide is carried out. The main group consisted of 30 patients, 22 male and 8 female, in the median age of 45.9 +/- 23 years. 22 patients out of those had 2nd stage essential hypertension, while the other 8 had 3rd stage. The control group consisted of 30 patients, 20 male and 10 female, in the median age of 45.1 + 1.3 years. 4 patients had 3rd stage essential hypertension, 26 patients had 2nd stage. The both groups were clinically comparable by the character and severity of the main disease, the carried out surgery (open cholecystectomy) and the qualification of surgeons. Results of the research showed, that low flow monoanesthesia with xenon abruptly eradicated the unfavourable consequences of induction of anesthesia (3-5 mg/kg of sodium thiopental or 2-2.5 mg/kg of propofol) and had a positive effect on the parameters of central hemodynamics of patients with essential hypertension. Xenon anesthesia, compared to nitrous oxide, rapidly stabilized the parameters of blood pressure and heart rate and can be recommended as a method of choice in patients with essential hypertension and compromised myocarium. Nitrous oxide with bolus of regular fentanyl doses doesn't reliable anesthesiological protection during open cholecystectomy and shows signs of toxicity. PMID:21692217

  10. Pain management and regional anesthesia for the dental patient.

    Science.gov (United States)

    Woodward, Tony M

    2008-05-01

    Current standards of care in veterinary medicine dictate an adequate level of pain control for our patients. Effective pain control uses a proactive, multimode approach that starts with preoperative medications, includes the anesthetic protocol selected, and continues into the postoperative period. A basic understanding of the physiology of pain assists in selecting those agents and modalities best suited for individual patients. Analgesic drug selection and local anesthesia are both integral parts of pain control when performing surgery in the oral cavity. Local (regional) anesthesia plays an important part in the pain control of oral surgical patients. Regional anesthetic techniques are used for many common oral procedures, including extractions, periodontal flap surgery, treatment of traumatic injuries of the oral cavity, tumor removal, palatal surgery, periodontal therapy, and root canal therapy. This presentation will cover strategies for analgesia and the techniques and materials used in local/regional anesthesia in the oral cavity. Anatomic landmarks and guidelines for effective regional blocks will be covered. PMID:18482711

  11. Anesthesia and cancer recurrences: The current knowledge and evidence

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2015-01-01

    Full Text Available Surgical removal of solid tumors is of utmost importance as total resection can be curative. The surgical insult however itself may result in tumor micrometastasis coupled with depression of cell-mediated immunity culminating in tumor recurrence. Recent research suggests that few anesthetic agents or procedures can influence pathophysiology of metastasis in the postoperative period. Whereas opioids and volatile anesthetics have been implicated in angiogenesis and immunosuppression, evidences accumulated over the recent years have undoubtedly highlighted the attenuation of immunosuppression by regional anesthetic agents thereby making it superior over general anesthesia in preventing cancer recurrence. As anesthetic drugs are given at that time when patient is at the maximum risk of spread of metastasis, thus an understanding of the effect of anesthesia drugs and their impact on tumor metastasis is important so that appropriate anesthetic strategy can be made to improve long term survival in these patients. The purpose of the present review is therefore to emphasize the pivotal role of various anesthetic agents and anesthesia techniques in preventing tumor recurrence after surgery.

  12. Alternating-pulse iontophoresis for targeted cutaneous anesthesia

    Science.gov (United States)

    Meyer, Peter F.; Oddsson, Lars I E.

    2003-01-01

    In studies of sensory contributions to motor control, it may be advantageous to temporarily reduce the sensitivity of specific sensory systems. This article details a method for non-invasively inducing cutaneous anesthesia, leaving proprioceptive and motor functions intact. This method, called alternating-pulse iontophoresis, differs from conventional direct-current (DC) iontophoretic drug delivery in that adjacent drug delivery electrodes are stimulated out-of-phase. The total current delivered at any instant is then less than that produced during a comparable DC application, while the uniformity of drug delivery is expected to improve. Effective delivery of local anesthetics to the cutaneous foot soles by alternating-pulse iontophoresis was demonstrated using cutaneous pressure sensory threshold levels (STL's) assessed with Semmes-Weinstein monofilaments (arbitrary units of perceived force, or a.u.). Thirteen of 16 healthy subjects achieved a level of anesthesia greater than or equal to that normally associated with clinical peripheral sensory neuropathy. Average STL's measured prior to the anesthesia procedure were 4.00 a.u. ( approximately 10 mN). Immediately following the procedure, STL's were elevated to an average of 5.40 a.u. ( approximately 246 mN) and averaged 4.97 a.u. ( approximately 92 mN) after 50 min of standing. A number of research and clinical applications for this technique are suggested.

  13. Superior subconjunctival anesthesia versus retrobulbar anesthesia for manual small-incision cataract surgery in a residency training program: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kongsap P

    2012-11-01

    Full Text Available Pipat KongsapDepartment of Ophthalmology, Prapokklao Hospital, Chanthaburi, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandPurpose: To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS performed by third-year residents.Design: A randomized, controlled trial.Patients and methods: A total of 150 patients undergoing routine cataract surgery were randomly assigned to receive either subconjunctival anesthesia (group 1, n = 75 or retrobulbar anesthesia (group 2, n = 75. Third-year residents performed MSICS using the modified Blumenthal technique. Subconjunctival anesthesia was administered by injecting 2% xylocaine with adrenalin into the superior conjunctiva, and retrobulbar anesthesia by injecting 2 mL of 2% xylocaine with adrenalin into the retrobulbar space. We studied the following variables: intraoperative pain score rated on a 100-point visual analog scale (VAS, operative time, and injection and operative complications.Results: A mean age of 69 vs 70 years, an operative time of 47.1 (SD, 9.9 min vs 47.7 (10.9 min, and a median (interquartile range pain score of 40 (range, 20–70 vs 40 (range, 20–50 were observed in the subconjunctival and the retrobulbar groups, respectively. The injection complication of subconjunctival hemorrhage was significantly higher in the subconjunctival group (25.3% compared to the retrobulbar group (1.3%. The operative complication rate between groups was not different (P > 0.05.Conclusion: Both, superior subconjunctival anesthesia and retrobulbar anesthesia were effective during MSICS when used in a residency training program.Keywords: subconjunctival anesthesia, retrobulbar anesthesia, cataract surgery, small-incision cataract surgery, visual analog scale, pain score

  14. MR arthrography of the shoulder: Do we need local anesthesia?

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio, E-mail: claudio.spick@meduniwien.ac.at [Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, 1090 Vienna (Austria); Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred [Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz (Austria)

    2014-06-15

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  15. REGIONAL ANESTHESIA CONTINUOUS BRACHIAL PLEXUS BLOCK WITH ULTRASONOGRAPHY GUIDANCE

    Directory of Open Access Journals (Sweden)

    T. G. A. Senapathi

    2015-03-01

    Full Text Available Background: Regional anesthesia has an anti-inflammatory effect that blockade the C-fiber hence reduced cytokine production and blocked the activity of the sympathetic nerve fibers. Postoperative pain caused primarily by tissue inflammation and activity of the C-fibers in the manner of reduced the production of cytokines, regional anesthesia may limit the inflammatory response after surgery and severity of postoperative pain. Methods: This study is a clinical experimental study with randomized pre and post test control group design. A total of 24 samples were recruited in this study divided into two groups each consisting of 12 samples. The first group was given regional anesthesia method of continuous brachial plexus block with ultrasound guidance and the second group with general anesthesia method. T-test or Mann-Whitney continued multivariate linear regression analysis was performed to analyze the differences in treatment and not because of differences in the initial values with significance level of p<0.05. Results: This study reports that the mean decreased levels of IL-6 postoperatively in 1stgroup is 29.8 lower than in 2ndgroup and it is statistically significant p< 0.05. There was an increase of IL-10 mean levels from preoperative to postoperatively with significance level of p<0.05 in both groups. Declined in the mean levels of PAF postoperatively in 1st group 1.3 lower than 2nd group and it was statistically significant p<0.05. The declined of  postoperative VAS in 1st group is 3.1 lower than 2nd group and it is statistically significant p< 0.05, and it also contained the pure effect of PAF levels against value of VAS that any increased 1ng/ml levels of PAF then an increase in the value of 0.18 cm VAS and this was statistically significant p<0.05. Selection of this anesthesia technique in orthopedic antebrachii surgery provides better inflammatory response and improved clinical outcomes.

  16. MR arthrography of the shoulder: Do we need local anesthesia?

    International Nuclear Information System (INIS)

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  17. Inhalational anesthesia for organ procurement: potential indications for administering inhalational anesthesia in the brain-dead organ donor.

    Science.gov (United States)

    Elkins, Laurie J

    2010-08-01

    Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. Literature searches were performed with the terms brain death, organ donor, organ procurement, anesthesia and organ donor, anesthesia and brain death, anesthesia and organ procurement, inhalational anesthetics and organ procurement, and inhalational anesthetics and brain dead. Additional resources were obtained from reference lists of published articles. The literature review showed there is a lack of published studies researching the use of inhalational anesthetics in organ procurement. No studies have been published evaluating the effect of preconditioning with inhalational agents (administering 1.3 minimal alveolar concentration of an inhalational agent for the 20 minutes before periods of ischemia) in the brain-dead organ donor population. Further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs. Anesthetic preconditioning before the ischemic period may reduce ischemia-reperfusion injury in transplanted organs, further increasing viability of transplanted organs. PMID:20879630

  18. Intravenous dex medetomidine or propofol adjuvant to spinal anesthesia in total knee replacement surgery

    International Nuclear Information System (INIS)

    The purpose of this study was to compare effect of intravenous dex medetomidine with the intravenous propofol adjuvant to spinal intrathecal anesthesia on the duration of spinal anesthesia and hemodynamic parameters during total knee replacement surgery. Supplementation of spinal anesthesia with intravenous dexemedetomidine or propofol produces good sedation levels without significant clinical hemodynamic changes. Adding dex medetomidine produces significantly longer sensory and motor block than propofol . (authors).

  19. General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis

    OpenAIRE

    Emery N Brown; Purdon, Patrick L.; Van Dort, Christa J.

    2011-01-01

    Placing a patient in a state of general anesthesia is crucial for safely and humanely performing most surgical and many nonsurgical procedures. How anesthetic drugs create the state of general anesthesia is considered a major mystery of modern medicine. Unconsciousness, induced by altered arousal and/or cognition, is perhaps the most fascinating behavioral state of general anesthesia. We perform a systems neuroscience analysis of the altered arousal states induced by five classes of intraveno...

  20. Recovery from desflurane anesthesia in horses with and without post-anesthetic xylazine

    OpenAIRE

    Aarnes, Turi K.; Bednarski, Richard M.; Bertone, Alicia L.; Hubbell, John A.E.; Lerche, Phillip

    2014-01-01

    The objective of this study was to compare recovery from desflurane anesthesia in horses with or without post-anesthetic xylazine. Six adult horses were anesthetized on 2 occasions, 14 d apart using a prospective, randomized crossover design. Horses were sedated with xylazine, induced to lateral recumbency with ketamine and diazepam, and anesthesia was maintained with desflurane. One of 2 treatments was administered intravenously at the end of anesthesia: xylazine [0.2 mg/kg body weight (BW)]...

  1. Properties of slow oscillation during slow-wave sleep and anesthesia in cats

    OpenAIRE

    Chauvette, Sylvain; Crochet, Sylvain; Volgushev, Maxim; Timofeev, Igor

    2011-01-01

    Deep anesthesia is commonly used as a model of slow-wave sleep (SWS). Ketamine-xylazine anesthesia reproduces the main features of sleep slow oscillation: slow, large amplitude waves in field potential, which are generated by the alternation of hyperpolarized and depolarized states of cortical neurons. However, direct quantitative comparison of field potential and membrane potential fluctuations during natural sleep and anesthesia is lacking, so it remains unclear how well the properties of s...

  2. PREDICTORS OF ATTITUDE OF PARTURIENTS SELECTED FOR CESAREAN SECTION TOWARD SPINAL ANESTHESIA

    OpenAIRE

    M.R. Afhami; P. Hassanzadeh Salmasi J. Rahimi Panahea

    2004-01-01

    There are many factors contributing to success of regional anesthesia. Patients’ attitude toward spinal anesthesia is one of the most important of these factors. This is a descriptive study performed on 100 healthy parturient selected for elective cesarean section in Alzahra Obstetric Hospital,Tabriz, Iran. The aim of this study was to evaluate patients’ attitude and their knowledge about spinal anesthesia. Patients were selected randomly. Data collection was performed using a questionnaire. ...

  3. A Comparison of Epidural Anesthesia and Lumbar Plexus-Sciatic Nerve Blocks for Knee Surgery

    OpenAIRE

    Eyup Horasanli; Mehmet Gamli; Yasar Pala; Mustafa Erol; Fazilet Sahin; Bayazit Dikmen

    2010-01-01

    OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves w...

  4. Inhibitory effect of pentobarbital anesthesia on venous stasis induced arteriolar vasoconstriction in the dog hindleg

    DEFF Research Database (Denmark)

    Bülow, J; Henriksen, O; Amtorp, Ole

    1984-01-01

    vasoconstrictor response was present in both tissues although the response in muscle tissue exhibited a great variation between the dogs during this period. However, after 4-5 h of anesthesia the response was abolished in both tissues. During neurolept anesthesia with fentanyl/N2O the same vasoconstrictor...... vasoconstrictor mechanism of the vascular smooth muscle cells or both. It is suggested that fentanyl/N2O anesthesia is better suited for this kind of studies....

  5. Monitored anesthesia care in a case of pheochromocytoma and atrial myxoma

    OpenAIRE

    Manvikar, Laxmi P.; Adhye, Bharati A.

    2012-01-01

    Anesthesia for a patient with pheochromocytoma is challenging; irrespective of whether it is a diagnosed case for planned surgery or an occult case, it can be a nightmare. The patient may be given anesthesia for removal of the primary tumor or for surgery other than for the removal of the primary tumor. Hemodynamic derangements like hypertension and arrhythmia can be catastrophic. Monitored anesthesia care, though used for many cases, is unusual for a patient with diagnosed pheochromocytoma, ...

  6. Sub-tenon anesthesia in the operation of cataract using phacoemulsification technique

    OpenAIRE

    Avramović Siniša; Vukosavljević Miroslav

    2008-01-01

    INTRODUCTION Already in 1884, Knapp reported a successful cataract operation using 5% of cocaine in eyedrops. Today, different methods of local anesthesia in the operation of cataract are used, such as retrobulbary, peribulbary, subconjunctival, sub-tenon, topical and intracameral anesthesia. Phacoemulsification is a modern approach to the operation of cataract that is increasingly applied in our country. Aiming to eliminate the risk of severe complications caused by retrobulbary anesthesia, ...

  7. Obesity is independently associated with spinal anesthesia outcomes: a prospective observational study.

    Directory of Open Access Journals (Sweden)

    Hyo-Jin Kim

    Full Text Available The influence of body-mass index (BMI on spinal anesthesia is still controversial, with discrepant results reported in previous studies. To compare spinal anesthesia in obese and non-obese subjects, the anesthesia profiles in patients who underwent spinal anesthesia using intrathecal hyperbaric bupivacaine were compared. A total of 209 patients undergoing elective total knee replacement arthroplasty (TKRA surgery under spinal anesthesia were divided into an NO (non-obese group (BMI < 30 kg/m2, n = 141 and an O (obese group (BMI ≥ 30 kg/m2, n = 68. Anesthesia was deemed successful if a bilateral T12 sensory block occurred within 15 minutes of intrathecal drug administration, and if the level of sensory block was higher than T12 when the surgery ended. Logistic regression analysis with multiple variables known to influence spinal anesthesia was performed to identify which parameters independently determined the spinal anesthesia outcome. Similar doses of bupivacaine were administered to the NO and O groups. The incidence of anesthesia failure was significantly lower in the O group [n = 43 (30.5% in the NO group vs. n = 10 (18.9% in the O group, p = 0.014]. The independent predictors for successful anesthesia in all patients were dose of hyperbaric bupivacaine [odds ratio (OR 2.12, 95% CI: 1.64-2.73] and obese status (BMI ≥ 30 kg/m2, OR 2.86, 95% CI: 1.25-6.52. Time to first report of postoperative pain and time to first self-void were significantly longer in the O group. These results suggest that the duration of block with hyperbaric bupivacaine is prolonged in obese patients and obesity is independently associated with spinal anesthesia outcomes, as is bupivacaine dosage. A further study enrolling patients with morbid obesity and using a fixed bupivacaine dosage is required to confirm the effect of obesity on spinal anesthesia.

  8. Prevention of thromboembolism following elective hip surgery. The value of regional anesthesia and graded compression stockings

    DEFF Research Database (Denmark)

    Wille-Jørgensen, P; Christensen, S W; Bjerg-Nielsen, A;

    1989-01-01

    -venous thrombosis was established by phlebography and the diagnosis of pulmonary embolism by pulmonary perfusion and ventilation scintigraphy. Of 65 patients surgically treated under general anesthesia, 20 (31%) developed deep-venous thrombosis and six developed pulmonary embolism. Of 33 patients surgically treated...... using regional anesthesia, three (9%) developed deep-venous thrombosis and one developed a pulmonary embolus. The number of patients developing deep-venous thrombosis was significantly lower in the group receiving regional anesthesia compared with the group receiving general anesthesia. The results...

  9. Does regional anesthesia influence early outcome of upper arm arteriovenous fistula?

    International Nuclear Information System (INIS)

    To assess the effect of regional anesthesia on the outcome of elbow arteriovenous fistula (AVF), prospectively studied consecutive patients with end-stage renal disease referred for permanent vascular access to the Vascular Unit of King Fahd University Hospital between September 2004 and September 2007. The patients were divided into 2 groups: Group 1: patients who underwent the construction of the AVF under regional anesthesia and Group 2: patients who were operated under general anesthesia, indicated by their preferences or failure of regional anesthesia. Data including patient characteristics and type of AVF were recorded. The internal diameter of the vein and the artery and intra-operative blood flow were measured. The complications of both types of anesthesia were recorded. The patients were followed up for three months. Eighty four cases were recruited in this study. Complete brachial plexus block was achieved in 57 (68%) patients. Seven patients were converted to general anesthesia and 20 patients had AVF under general anesthesia from the start. There were no significant differences between the 2 groups with regard to basic characteristics or operative data. There were no instances of systemic toxicity, hematomas, or nerve injury from the regional block. No major complications were reported from the general anesthesia. There was no significant difference between both groups regarding early failure of AVF (Group 1, 14% vs. Group2; 11%. P= 0.80). No significant advantage of regional over general anesthesia in terms of early outcome of AVF was seen in this study (Author).

  10. Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Oturai, P; Erichsen, C J; Pedersen, M H; Kehlet, H

    1994-01-01

    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the...... development of late postoperative constant and episodic hypoxemia, which instead may be related to the magnitude of trauma and/or opioid administration....

  11. Is it possible to predict hypotension during onset of spinal anesthesia in elderly patients?

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Haarmark, Christian; Kanters, Jørgen K; Rasmussen, Lars S

    2009-01-01

    STUDY OBJECTIVE: To evaluate the sensitivity and specificity of various predictors of hypotension during onset of spinal anesthesia in elderly patients. DESIGN: Prospective study. SETTING: 32 ASA physical status I, II, and III patients, aged >or=60 years, scheduled for elective lower limb surgery...... with spinal anesthesia. INTERVENTIONS: Patients received spinal anesthesia with 10-17.5 mg of bupivacaine. No prophylactic ephedrine or fluid preloading was used. MEASUREMENTS: A 5-minute baseline was recorded and during onset of spinal anesthesia, hemodynamic changes were measured every 10 seconds...

  12. Influencing Anesthesia Provider Behavior Using Anesthesia Information Management System Data for Near Real-Time Alerts and Post Hoc Reports.

    Science.gov (United States)

    Epstein, Richard H; Dexter, Franklin; Patel, Neil

    2015-09-01

    In this review article, we address issues related to using data from anesthesia information management systems (AIMS) to deliver near real-time alerts via AIMS workstation popups and/or alphanumeric pagers and post hoc reports via e-mail. We focus on reports and alerts for influencing the behavior of anesthesia providers (i.e., anesthesiologists, anesthesia residents, and nurse anesthetists). Multiple studies have shown that anesthesia clinical decision support (CDS) improves adherence to protocols and increases financial performance through facilitation of billing, regulatory, and compliance documentation; however, improved clinical outcomes have not been demonstrated. We inform developers and users of feedback systems about the multitude of concerns to consider during development and implementation of CDS to increase its effectiveness and to mitigate its potentially disruptive aspects. We discuss the timing and modalities used to deliver messages, implications of outlier-only versus individualized feedback, the need to consider possible unintended consequences of such feedback, regulations, sustainability, and portability among systems. We discuss statistical issues related to the appropriate evaluation of CDS efficacy. We provide a systematic review of the published literature (indexed in PubMed) of anesthesia CDS and offer 2 case studies of CDS interventions using AIMS data from our own institution illustrating the salient points. Because of the considerable expense and complexity of maintaining near real-time CDS systems, as compared with providing individual reports via e-mail after the fact, we suggest that if the same goal can be accomplished via delayed reporting versus immediate feedback, the former approach is preferable. Nevertheless, some processes require near real-time alerts to produce the desired improvement. Post hoc e-mail reporting from enterprise-wide electronic health record systems is straightforward and can be accomplished using system

  13. Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial

    Directory of Open Access Journals (Sweden)

    Writuparna Das

    2015-01-01

    Full Text Available Background: Laparoscopy though minimally invasive produces significant hemodynamic surge and neuroendocrine stress response. Though general anesthesia (GA is the conventional technique, now-a-days, regional anesthesia has been accepted for laparoscopic diagnostic procedures, and its use is also being extended to laparoscopic surgeries. Objective: The aim was to compare the hemodynamic surge and neuroendocrine stress response during laparoscopic cholecystectomy (LC under GA and spinal anesthesia (SA in American Society of Anesthesiologists (ASA PS 1 patients. Materials and Methods: Thirty ASA physical status I patients, aged 18-65 years were randomly allocated into two equal groups of 15 each. Group A received GA with controlled ventilation. Patients were preoxygenated for 5 min with 100/5 oxygen, premedicated with midazolam 0.03 mg/kg intravenous (i.v, fentanyl 2 mcg/kg i.v; induction was done with thiopentone 3-5 mg/kg i.v; intubation was achieved after muscle relaxation with 0.5 mg/kg atracurium besylate i.v. Anesthesia was maintained with 1-2% sevoflurane and N2O:O2 (60:40 and intermittent i.v injection of atracurium besylate. Group B SA with 0.5% hyperbaric bupivacaine and 25 μg fentanyl along with local anesthetic instillation in the subdiaphragmatic space. Mean arterial pressure, heart rate (HR, oxygen saturation, end tidal carbon-dioxide were recorded. Venous blood was collected for cortisol assay before induction and 30 min after pneumoperitoneum. All data were collected in Microsoft excel sheet and statistically analyzed using SPSS software version 16 (SPSS Inc., Chicago, IL, USA. All numerical data were analyzed using Student′s t-test and paired t-test. Any value <0.05 was taken as significant. Results: Mean arterial pressure and mean HR and postpneumoperitoneum cortisol level were lower in group B than group A though the difference was not statistically significant in hemodynamic parameters but significant in case of cortisol

  14. Properties of slow oscillation during slow-wave sleep and anesthesia in cats.

    Science.gov (United States)

    Chauvette, Sylvain; Crochet, Sylvain; Volgushev, Maxim; Timofeev, Igor

    2011-10-19

    Deep anesthesia is commonly used as a model of slow-wave sleep (SWS). Ketamine-xylazine anesthesia reproduces the main features of sleep slow oscillation: slow, large-amplitude waves in field potential, which are generated by the alternation of hyperpolarized and depolarized states of cortical neurons. However, direct quantitative comparison of field potential and membrane potential fluctuations during natural sleep and anesthesia is lacking, so it remains unclear how well the properties of sleep slow oscillation are reproduced by the ketamine-xylazine anesthesia model. Here, we used field potential and intracellular recordings in different cortical areas in the cat to directly compare properties of slow oscillation during natural sleep and ketamine-xylazine anesthesia. During SWS cortical activity showed higher power in the slow/delta (0.1-4 Hz) and spindle (8-14 Hz) frequency range, whereas under anesthesia the power in the gamma band (30-100 Hz) was higher. During anesthesia, slow waves were more rhythmic and more synchronous across the cortex. Intracellular recordings revealed that silent states were longer and the amplitude of membrane potential around transition between active and silent states was bigger under anesthesia. Slow waves were mostly uniform across cortical areas under anesthesia, but in SWS, they were most pronounced in associative and visual areas but smaller and less regular in somatosensory and motor cortices. We conclude that, although the main features of the slow oscillation in sleep and anesthesia appear similar, multiple cellular and network features are differently expressed during natural SWS compared with ketamine-xylazine anesthesia. PMID:22016533

  15. Post anesthesia recovery rate evaluated by using White fast tracking scoring system

    Directory of Open Access Journals (Sweden)

    Munevera Hadžimešić

    2013-12-01

    Full Text Available Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate.Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system.Results: Significant difference was observed only 1 minute after extubation (p=0,025 finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046. In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008. Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference.Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost.

  16. Simultaneous Bilateral Cataract Surgery in General Anesthesia Patients

    Directory of Open Access Journals (Sweden)

    Tien-En Huang

    2007-04-01

    Full Text Available Background: The aim of this study was to evaluate the indications, safety, benefits, disadvantagesand advantages, and the visual outcomes for simultaneous bilateralcataract surgery (SBCS under general anesthesia.Methods: This retrospective case review pertained to a period spanning from June1998 through June 2005 inclusively, and comprised of 27 consecutivepatients (54 eyes that underwent simultaneous bilateral cataract surgeryunder general anesthesia at the Kaohsiung Chang Gung Memorial Hospital,Taiwan. Surgery modalities included phacoemulsification, extracapsularcataract extraction, lens aspiration and intraocular lens implantation.Outcome measures included postoperative best correct visual acuity (BCVAas well as intraoperative and postoperative complication rates. Due to thebipolas distribution of the age, we arbitrarily divided our cases into youngergroup (Group Y, younger than 20 years old and older group (Group O, equalto or older than 20 years old.Results: Thirty-eight of the 54 eyes (60% in the younger group and 76.5% in theolder group, featuring measured preoperative and postoperative BSCVA,achieved improved visual acuity following SBCS. Two eyes (5.9% in theolder group demonstrated poorer visual acuity postoperatively than preoperatively.Seven patients (40% in the younger group and 17.6% in the oldergroup were not able to express VA due to their particular medical conditionssuch as mental disease and young age. Intraoperative and postoperative complicationrates were similar to those cited in previous reports of analogousbut unilateral extracapsular surgery and simultaneous bilateral cataractsurgery. Endophthalmitis did not arise in any of the eyes operated upon andreported on herein, and no examples of bilateral complications that resultedin visual loss occurred in our patients.Conclusion: SBCS could be a good choice when cataract surgery needs to be performedunder general anesthesia. The relative benefits of SBCS under general

  17. Epidural anesthesia as a cause of acquired spinal subarachnoid cysts

    International Nuclear Information System (INIS)

    Six patients with acquired spinal subarachnoid cysts secondary to epidural anesthesia were evaluated with MR imaging (seven patients) and intraoperative US (three patients). The cysts were located in the lower cervical and thoracic spine. Adhesions and irregularity of the cord surface were frequently noted. Associated intramedullary lesions, including intramedullary cysts and myelomalacia, were seen in two of the patients. Arachnoiditis was unsuspected clinically in three patients, and MR imaging proved to be the diagnostic examination that first suggested the cause of the patients symptoms. The underlying mechanism for the formation of these cysts is a chemically induced arachnoiditis

  18. Combination of spinal anesthesia and peripheral nerve block: Case report

    Directory of Open Access Journals (Sweden)

    Vildan Temel

    2010-12-01

    Full Text Available Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery.

  19. Balanced anesthesia and constant-rate infusions in horses.

    Science.gov (United States)

    Valverde, Alexander

    2013-04-01

    Balanced anesthetic techniques are commonly used in equine patients, and include the combination of a volatile anesthetic with at least one injectable anesthetic throughout the maintenance period. Injectable anesthetics used in balanced anesthesia include the α2-agonists, lidocaine, ketamine, and opioids, and those with muscle-relaxant properties such as benzodiazepines and guaifenesin. Administration of these injectable anesthetics is best using constant-rate infusions based on the pharmacokinetics of the drug, which allows steady-state concentrations and predictable pharmacodynamic actions. This review summarizes the different drug combinations used in horses, and provides calculated recommended doses based on the pharmacokinetics of individual drugs. PMID:23498047

  20. Early experiences of vasodilators and hypotensive anesthesia in children.

    Science.gov (United States)

    Brown, T C K

    2012-07-01

    The physiological application of OHMS LAW explains the basis of hypotensive anesthesia. V = IR translates into: Pressure = Flow × Resistance or Blood pressure = Cardiac Output × Peripheral Resistance. If peripheral resistance is reduced by a vasodilator such as sodium nitroprusside (a short acting, vascular smooth muscle relaxant) or phenoxybenzamine (a long acting α adrenoreceptor antagonist), blood pressure will fall and vasoconstriction and bleeding will be reduced. A less desirable alternative to lowering blood pressure could be to reduce cardiac output by suppressing myocardial contractility using a ß(1) adrenoceptor antagonist or an inhalational agent such as isoflurane. PMID:22243693

  1. Awake anesthesia for resection of gliomas located in eloquent brain

    Directory of Open Access Journals (Sweden)

    WANG De-xiang

    2012-12-01

    Full Text Available Intraoperative awake anesthesia is a safe and reliable method performed in glioma surgery in brain eloquent areas, for the purpose of a maximum resection of the lesions and protection of brain function. Plasma target-controlled infusion (TCI is used in the course of opening cranium and closing cranium to maintain optimal sedation, which is supplemented by excellent scalp nerve block for analgesia, and a laryngeal mask is used to secure the patient's airway. During cerebral function monitoring and lesion excision, appropriately modifying the plasma concentration of propofol TCI can make the patient achieve optimal sedation.

  2. Peribulbar anesthesia for the repair of orbital floor fractures.

    Science.gov (United States)

    Kezirian, G M; Hill, F D; Hill, F J

    1991-10-01

    Four patients underwent successful repair of an isolated orbital floor fracture under local anesthesia. The surgical approach was by antero-inferior orbitotomy, with placement of a Nylamid plate (S Jackson Inc, Washington, DC). The anesthetic technique used was a peribulbar and infratrochlear nerve block with local supplementation. Digital control of the globe was maintained during the peribulbar injection to prevent ocular perforation. We conclude that local anesthetic for this procedure in carefully selected cases is safe and efficacious, avoiding the morbidity of a general anesthetic. PMID:1961618

  3. [Peroneal nerve injury: anesthesia is not always to blame].

    Science.gov (United States)

    Curt Nuño, F; López Álvarez, S; Juncal Díaz, J; Domínguez Chaos, A; Llorca González, F; Pensado Castiñeiras, A

    2015-02-01

    We introduce a case report of a woman that was operated of foot surgery under locoregional anesthesia with an echo-guided peripheral sciatic-popliteal nerve block. As post operatory complication a peroneal nerve injury was noticed. We revised differential diagnosis of peripheral nerve block and therapeutic strategy we should take. In our case the finding was a high degree axonotmesis secondary to extrinsic compressure due to pneumatic tourniquet placed in the ankle used during surgery. There was no relationship with the anesthetic technique. PMID:25048997

  4. Anesthesia for hemicolectomy in a known porphyric with cecal malignancy

    Directory of Open Access Journals (Sweden)

    B K Naithani

    2015-01-01

    Full Text Available Intraoperative management of a known acute intermittent porphyria patient is a challenge requiring awareness of factors, which trigger an acute crisis, clinical features of a porphyric attack, knowledge of safe pharmacologic intervention, and preparedness for reintubation and ventilatory support. The classical signs of a porphyric crisis such as pain abdomen, vomiting and neuropsychiatric symptoms are masked under general anesthesia and can be confused with postoperative pain and vomiting and postoperative cognitive dysfunction, especially for intra-abdominal surgeries. Eternal vigilance for onset of an acute crisis is imperative. After a crisis of acute intermittent porphyria, residual paresis may persist for years in the absence of further attacks.

  5. Anesthesia for an achondroplastic individual with coexisting atlantoaxial dislocation.

    Science.gov (United States)

    Kaushal, Ashutosh; Haldar, Rudrashish; Ambesh, Paurush

    2015-01-01

    Achondroplasia is a congenital, disfiguring condition which is the most common form of short-limbed dwarfism. Defective cartilage formation is the hallmark of this condition, which results in a wide spectrum of skeletal abnormalities including spinal defects. Various other systems such as cardiac, pulmonary, and neurological can be simultaneously affected adversely including airway defects. Anesthetic management of such individuals is complicated because of their multisystem affliction. Concomitant atlantoaxial dislocation can further amplify the difficulty during the administration of anesthesia in such patients. We report the successful anesthetic conduct of such a patient with the positive outcome. PMID:26712995

  6. Spinal Anesthesia Management in Central Core Disease: A Case Report

    OpenAIRE

    SARIHASAN, Binnur

    2006-01-01

    Central core disease is a rare neuromuscular disorder associated with leg weakness. It is a familial disease with autosomal dominant inheritance. Central core disease has been reported to be associated with malignant hyperthermia. A 25-year-old woman with central core disease was scheduled to be operated for lumbar disc hernia at L4-5 and L5-S1 interspaces. Oral dantrolene was administered prophylactically. Spinal anesthesia was performed with a 25 G Whitacre spinal needle at the L3-4 intersp...

  7. General anesthesia for the heaviest man in the world

    OpenAIRE

    Abdullah S. Terkawi; Mahmood Rafiq; Reaad Algadaan; Insha Ur Rehman; Doais, Khaled S.; Durieux, Marcel E.; Mazen AlSohaibani

    2014-01-01

    The prevalence of obesity has increased greatly over the last 20 years, resulting in an increase in the number of bariatric and nonbariatric surgeries in this population. We present the case of a 20-year-old male, weighing 610 kg (1345 lb), and believed to be the heaviest living man in the world. After 4 months of rigorous in-hospital weight reduction, now weighing 510 kg (1125 lb), he underwent a laparoscopic gastric sleeve procedure under general anesthesia. This report describes the manage...

  8. General anesthesia for the heaviest man in the world

    Directory of Open Access Journals (Sweden)

    Abdullah S Terkawi

    2014-01-01

    Full Text Available The prevalence of obesity has increased greatly over the last 20 years, resulting in an increase in the number of bariatric and nonbariatric surgeries in this population. We present the case of a 20-year-old male, weighing 610 kg (1345 lb, and believed to be the heaviest living man in the world. After 4 months of rigorous in-hospital weight reduction, now weighing 510 kg (1125 lb, he underwent a laparoscopic gastric sleeve procedure under general anesthesia. This report describes the management of his anesthetic and exemplifies the challenges associated with this patient population.

  9. Total Intravenous Versus Inhalation Anesthesia in Patients Undergoing Laparoscopic Cholecystectomies. Effects on Two Proinflammatory Cytokines Serum Levels: Il-32 and TNF-Alfa.

    Directory of Open Access Journals (Sweden)

    Hadade Adina

    2016-01-01

    Full Text Available Introduction: It has been reported that as compared with total intravenous anesthesia (TIVA, inhalation anesthesia is increasing the postoperative level of proinflammatory interleukins.

  10. Effect of different anesthesia methods on plasma neuropeptides levels during the peri-operative period in surgical patients with hypertension

    International Nuclear Information System (INIS)

    Objective: To explore the effect of different anesthesia methods on the levels of plasma neuropeptides during the peri-operative period in patients with hypertension. Methods: Ninety hypertensive patients undergoing upper abdominal operations were randomly allocated to equal divided epidural anesthesia, general anesthesia and combined Groups. Plasma neuropeptide Y(NPY) concentrations were measured before anesthesia, at 15 min after anesthesia, 20 min after operation and 10 min after completion of the operation. Results: BP, HR and NPY were significantly changed in both E group and G group after anesthesia and operation (compared vs before anesthesia, p<0.01). BP, HR and NPY were significantly changed in C group after operation compared with those in both E and G group (p<0.05) . Conclusion: The combined anesthesia method is effective in inhibits the stress response during upper abdominal operation in the hypertensive patients

  11. Anesthetic strategy during endovascular therapy: General anesthesia or conscious sedation? (GOLIATH - General or Local Anesthesia in Intra Arterial Therapy) A single-center randomized trial

    DEFF Research Database (Denmark)

    Simonsen, Claus Z; Sørensen, Leif H; Juul, Niels;

    2016-01-01

    RATIONALE: Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes...... compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. AIM AND HYPOTHESIS: The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether...... study. Patients with acute ischemic stroke, scheduled for endovascular therapy, are randomized to receive either general anesthesia or conscious sedation. STUDY OUTCOMES: The primary outcome measure is infarct growth after 48-72 h (determined by serial diffusion-weighted magnetic resonance imaging...

  12. Effectiveness of Ibuprofen Administration on the Depth of Anesthesia in Inflamed Teeth

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    R Mahmodi

    2006-07-01

    Full Text Available Introduction: Incomplete anesthesia of inflamed teeth is a well known clinical occurrence and the purpose of this study was to evaluate the effectiveness of Ibuprofen as a premedication in improving the quality of anesthesia in patients with inflamed teeth pulps. Methods: Forty patients with the diagnosis of irreversible pulpitis in one mandibular tooth were selected. Two other teeth in the same quadrant were selected as controls. Electric pulp tester (EPT was used in this study to evaluate the quality of anesthesia. The subjects were divided into two groups randomly, and after recording of pulp tester response in each group, one of the two drugs; ibuprofen or placebo was administered 1 hour prior to anesthesia injection. After injection, EPT measurement was recorded. The reversed EPT scale was used for evaluation of the depth of anesthesia. Results : Data was analyzed to statistically compare the results before and after anesthesia and drug administration in cases and control group .Significantly lower TSLs were observed in the ibuprofen group (Pvalue= 0.001. Conclusion: This study concluded that preoperative administration of ibuprofen (if not contraindicated 1 hour before local anesthesia injection is an effective method for achieving deep anesthesia during RCT of teeth with irreversible pulpitis.

  13. Professional Socialization in Nurse Anesthesia Educational Programs: Attitudes and Beliefs of Faculty Members and Recent Graduates

    Science.gov (United States)

    Buettner, Kevin Charles

    2013-01-01

    The purpose of this study was to better understand professional socialization in nurse anesthesia educational programs through an exploration of the attitudes and beliefs of faculty members and recent graduates. Participants for this cross-sectional, quasi-experimental online study included a convenience sample of 178 nurse anesthesia faculty…

  14. The effects of anesthesia method on throat pain after elective rhinoplasty

    Directory of Open Access Journals (Sweden)

    Hedayatollah Elyassi

    2011-01-01

    Conclusions: Method of anesthesia had no independent role in predicting throat pain. Although larynx of subjects undergoing general anesthesia is manipulated by tracheal intubation, sedation has its specific risks for promoting throat pain after surgery. Therefore, neither CS nor GA is superior in terms of throat pain.

  15. Anesthesia management in a pediatric patient with Dandy-Walker syndrome

    OpenAIRE

    Çelik, Feyzi; Tüfek, Adnan; Temel, Vildan; Akdemir, Salim; Yıldırım, Zeynep Baysal; Kavak, Gönül Ölmez

    2011-01-01

    General anesthesia management of patients with Dandy-Walker syndrome is important since intubation may be difficult due to concomitant anomalies such as hydrocephalus, micrognathia and cleft palate. It should be considered that these patients may require postoperative intensive care support. In this article, anesthesia management of a patient with Dandy-Walker syndrome underwent persistent ventriculo-peritoneal shunt was presented.

  16. [History of pediatric anesthesia: from the beginnings to the end of the 19th century].

    Science.gov (United States)

    Sabourdin, N

    2013-12-01

    The first intuitions and descriptions of anesthesia can be found in the antique civilizations. In the 19th century, the invention of anesthesia took place in Boston, and quickly spread to Europe. In France, regulations and structures were created before the beginning of the 20th century to organize this new profession, for children as well as for adults. PMID:24211002

  17. INFLUENCE OF VARIOUS METHODS OF POSTOPERATIVE ANESTHESIA ON THE STATUS OF HAEMOSTASIS SYSTEM IN HIP REPLACEMENT

    Directory of Open Access Journals (Sweden)

    V. V. Borin

    2015-12-01

    Full Text Available 120 patients were examined using instrumental methods, such as hemocoagulography and agregatography. It has been various methods of postoperative anesthesia have different effect on the functional status of haemostasis system following hip replacement. Optimization of postoperative anesthesia provides a way of preventing thrombohemorrhagic complications 

  18. Anesthesia differentially modulates spontaneous network dynamics by cortical area and layer.

    Science.gov (United States)

    Sellers, Kristin K; Bennett, Davis V; Hutt, Axel; Fröhlich, Flavio

    2013-12-01

    Anesthesia is widely used in medicine and research to achieve altered states of consciousness and cognition. Whereas changes to macroscopic cortical activity patterns by anesthesia measured at the spatial resolution of electroencephalography have been widely studied, modulation of mesoscopic and microscopic network dynamics by anesthesia remain poorly understood. To address this gap in knowledge, we recorded spontaneous mesoscopic (local field potential) and microscopic (multiunit activity) network dynamics in primary visual cortex (V1) and prefrontal cortex (PFC) of awake and isoflurane anesthetized ferrets (Mustela putoris furo). This approach allowed for examination of activity as a function of cortical area, cortical layer, and anesthetic depth with much higher spatial and temporal resolution than in previous studies. We hypothesized that a primary sensory area and an association cortical area would exhibit different patterns of network modulation by anesthesia due to their different functional roles. Indeed, we found effects specific to cortical area and cortical layer. V1 exhibited minimal changes in rhythmic structure with anesthesia but differential modulation of input layer IV. In contrast, anesthesia profoundly altered spectral power in PFC, with more uniform modulation across cortical layers. Our results demonstrate that anesthesia modulates spontaneous cortical activity in an area- and layer-specific manner. These finding provide the basis for 1) refining anesthesia monitoring algorithms, 2) reevaluating the large number of systems neuroscience studies performed in anesthetized animals, and 3) increasing our understanding of differential dynamics across cortical layers and areas. PMID:24047911

  19. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia.

    Science.gov (United States)

    Davis, K Rennis; Vadakkan, D Thomas; Krishnakumar, E V; Anas, A Muhammed

    2015-01-01

    Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia. PMID:25814803

  20. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia

    OpenAIRE

    K Rennis Davis; D Thomas Vadakkan; Krishnakumar, E. V.; A Muhammed Anas

    2015-01-01

    Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia.

  1. GENERAL ANESTHESIA: IS IT SAFE FOR NEWBORNS, INFANTS AND YOUNG CHILDREN ?

    Directory of Open Access Journals (Sweden)

    Jasminka Nancheva

    2016-07-01

    Full Text Available The exposure of neonates, infants and small children to general anesthesia is becoming a common occurrence. Accumulating preclinical data indicate that exposure to commonly used general anesthetic agents during key periods of brain development in this population(between late gestation and 3 to 4 years of age, can lead to apoptotic neurodegeneration, synapse loss, and cognitive and neurobehavioral deficits that persist as the organism matures. New work suggests that infants and small children undergoing some types of surgery could have better recovery if they receive regional anesthesia rather than general anesthesia. In response to this concerns, the Food and drug administration (FDA and the International Research Society in anesthesia (IARS started an initiative called Smart Tots (Strategies for Mitigating Anesthesia- related neuro Toxicity in Tots which examine the effects of anesthesia on brain development. Also another two major prospective studies are ongoing in children : PANDA (Pediatric Anesthesia Neurodevelopment assessment Study project is a large, multi-center study based at the Morgan Stanley Children’s Hospital of New York at Columbia University, and another one is GAS study which is a multisite randomized controlled trial comparing neurodevelopment outcomes in infant receiving general anesthesia compared to spinal and other regional anesthetics to the stress response to surgery. The findings from these studies will help researches to design the safest anesthetic regimens and to develop the new and safer anesthetic drugs for use in pediatric medicine.

  2. Rupture of the Pulmonary Alveoli During General Anesthesia1,2

    OpenAIRE

    Miller, Ronald; Bongiorno, Frank

    1983-01-01

    The rupture of pulmonary alveoli during the induction of general anesthesia is a significant complication of general anesthesia that has been seldom reported in our literature. This article documents this occurrence in a patient scheduled for elective orthognathic surgery. The diagnosis and treatment are discussed.

  3. Myocardial fibrosis in a horse with polymorphic ventricular tachycardia observed during general anesthesia

    OpenAIRE

    Coudry, Virginie; Jean, Daniel; Desbois, Christophe; Tnibar, Aziz; Laugier, Claire; George, Catherine

    2007-01-01

    Ventricular dysrhythmias are more commonly associated with myocardial disease than are supraventricular dysrhythmias. Management of arrhythmias under general anesthesia is difficult because of the dysrhythmogenic effects of the anesthetic drugs. This report describes a severe ventricular dysrhythmia observed in a pony under general anesthesia, with a severe and old myocardial fibrosis found on postmortem examination.

  4. Inhalation anesthesia in dumeril´s monitor with isofluane, sevofluane, and nitrus oxide

    DEFF Research Database (Denmark)

    Bertelsen, Mads Frost; Mosley, Craig; Crawshaw, Graham J.; Dyson, Doris; Smith, Dale A.

    2005-01-01

    Induction and recovery from inhalation anesthesia of Dumeril´s monitors using isoflurane, sevoflurane and nitrus oxide were characterized using a randomized crossover design.......Induction and recovery from inhalation anesthesia of Dumeril´s monitors using isoflurane, sevoflurane and nitrus oxide were characterized using a randomized crossover design....

  5. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia

    Directory of Open Access Journals (Sweden)

    K Rennis Davis

    2015-01-01

    Full Text Available Pulmonary alveolar proteinosis (PAP is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia.

  6. Case Sequencing of Diagnostic Imaging Studies Performed Under General Anesthesia or Monitored Anesthesia Care During Nights and Weekends.

    Science.gov (United States)

    Mueller, Rashmi N; Dexter, Franklin; Truong, Van-Anh; Wachtel, Ruth E

    2015-11-01

    General anesthesia or monitored anesthesia care sometimes is provided in nonoperating room (OR) locations during nights and weekends (e.g., for magnetic resonance imaging [MRI] or computerized tomography [CT]). Rational and consistent scheduling and sequencing decisions for these diagnostic imaging procedures, including coordination with OR cases, cannot be done without knowing how long each case can wait to be started without risking a worsening of the patient's condition. We reviewed the medical records of the 81 patients who underwent diagnostic imaging procedures (78 = MRI, 3 = CT scan) under general anesthesia or monitored anesthesia care either on weekends or between 6 pm and 6 am at the University of Iowa Hospitals between March 2012 and February 2014. For 77.8% of patients, the indications could have changed clinical management within 4 hours (N = 63/81). Among the 63 imaging studies with potential immediate impact, there was documentation of results having been communicated to the treating team within 4 hours of the completion of imaging for 39 of the patients. Among the 39 patients, 15 promptly received medications or underwent procedures based on the imaging results. Thus, 15 of the 81 patients had a change in care (18.5%, 95% lower confidence limit = 11.2%). Our results are important since we showed previously that it is not possible to make rational and consistent decisions in case sequencing without knowing how long each case (including diagnostic imaging procedures) can wait to be started without a change in the patient's risk. The scheduled surgical procedure itself provides sufficient information to assess safe waiting times to start add-on cases (e.g., appendectomy). In contrast, MRI provides no context as to how potential findings will influence treatment. Our results show that the assumption cannot reasonably be made when sequencing cases that all imaging studies can or cannot wait longer than pending surgical procedures. Our results show that

  7. Propofol-Based Sedation Versus General Anesthesia for Endoscopic Submucosal Dissection.

    Science.gov (United States)

    Yurtlu, Derya Arslan; Aslan, Fatih; Ayvat, Pinar; Isik, Yasemin; Karakus, Nesli; Ünsal, Belkis; Kizilkaya, Mehmet

    2016-05-01

    The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gag reflex, nausea, vomiting, cough, number of desaturation episodes (SpO2 fentanyl were significantly higher (P < 0.05). Anesthesia time, postoperative anesthesia care unit, and hospital stay durations were not significantly different between the groups.General anesthesia increased dissection speed and enhanced endoscopist performance when compared with propofol-based sedation technique. PMID:27196474

  8. Comparison of remifentanil and low-dose fentanyl for fast-track cardiac anesthesia

    DEFF Research Database (Denmark)

    Khanykin, Boris; Siddiqi, Rizwan; Jensen, Per F; Bigler, Dennis R; Atroshchenko, Gennady V

    2013-01-01

    the drug infusion, which may increase the risk of an ischemic event. We conducted this randomized study to compare the efficacy of remifentanil versus low doses of fentanyl in fast-track cardiac anesthesia. It has been hypothesized that remifentanil would provide a safe anesthesia with no impact on...... myocardial function and with positive effects on extubation time and mobilization. METHODS: We compared the postoperative course of patients, the remifentanil group (RG) and the low-dose fentanyl group (LDFG), in whom remifentanil and low-dose fentanyl, respectively, were used for fast-track cardiac...... myocardial function. Both remifentanil and low-dose fentanyl are equally effective and safe for fast-track cardiac anesthesia. The study did not highlight any statistical superiority of remifentanil anesthesia over low-dose fentanyl anesthesia....

  9. The Study of Oral Clonidine Effect in Duration of Spinal Anesthesia with Lidocaine and Its Complications

    Directory of Open Access Journals (Sweden)

    M. Baalbaki

    2003-07-01

    Full Text Available There are many kinds of intervention to prolong the duration of spinal anesthesia which one of them is preoperation oral drugs. The purpose of this study was determination of clonidine effects in duration of spinal anesthesia and its complications. This study was a double - blinded randomized controlled clinical trial in 40-60 years old males of Mobasher and Ekbatan hospitals in Hamadan. In this study there were 40 cases candidated for spinal anesthesia and we divided them to 2 groups i.e. test and control then the results were recorded on questionnaire sheets. The test cases were prescribed 0.2 mg clonidine P.O. preoperatively and their duration of spinal anesthesia prolonged 11 minutes averagely and decreased its complications related to control prescribed placebo. Hence , the result showed preparation oral clonidine prolongs the duration of spinal anesthesia and decreases its complications like hypotention , nausea and vomiting.

  10. Anesthesia Management in a Patient with Niemann Pick Disease

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    Zeynep Akoğul

    2013-04-01

    Full Text Available Niemann-Pick disease (NPD is an autosomal recessive, lipid storage disorder caused by the deficiency of the lysosomal enzyme sphingomyelinase or defective cholesterol transport from lysosome to cytosol. The clinical symptoms and signs include dysphagia, loss of motor function, hepatosplenomegaly, recurred respiratory infections, seizure, mental retardation, spasticity, myoclonic jerks and ataxia, but vary depending on the type of this disease. According to the observed pathology, patients require specialized therapy. Due to the high prevalence of the pathology in this group of patients, surgical interventions requiring general anaesthesia are common. Anesthetists have some difficulties with this group of patients. One of them is difficult ventilation because of hepatosplenomegaly and the other is difficult intubation. The metabolism of some of the anesthetic agents may be affected due to chronic use of anticonvulsant agents. Liver enzymes are elevated and platelet counts are reduced. Here we report an anesthesia management, difficulties and post-op follow up in a female child having NPD. Anesthetists have some difficulties in ventilation and intubation with NPD patients. In this situation ventilation should be with low tidal volume and high frequency. Because anesthetic agents might cause liver damage, they should be used cautiously. As a result, with keeping mind all these pathologies, anesthesia management to these patients should be used cautiously. (Journal of Current Pediatrics 2013; 11: 42-4

  11. Alterations in glucose kinetics induced by pentobarbital anesthesia

    International Nuclear Information System (INIS)

    Because pentobarbital is often used in investigations related to carbohydrate metabolism, the in vivo effect of this drug on glucose homeostasis was studied. Glucose kinetics assessed by the constant intravenous infusion of [6-3H]- and [U-14C]glucose, were determined in three groups of catheterized fasted rats: conscious, anesthetized and body temperature maintained, and anesthetized but body temperature not maintained. After induction of anesthesia, marked hypothermia developed in rats not provided with external heat. Anesthetized rats that developed hypothermia showed a decrease in mean arterial blood pressure (25%) and heart rate (40%). Likewise, the plasma lactate concentration and the rates of glucose appearance, recycling, and metabolic clearance were reduced by 30-50% in the hypothermic anesthetized rats. Changes in whole-body carbohydrate metabolism were prevented when body temperature was maintained. Because plasma pentobarbital levels were similar between the euthermic and hypothermic rats during the first 2 h of the experiment, the rapid reduction in glucose metabolism in this latter group appears related to the decrease in body temperature. The continuous infusion of epinephrine produced alterations in glucose kinetics that were not different between conscious animals and anesthetized rats with body temperature maintained. Thus pentobarbital-anesthetized rats became hypothermic when kept at room temperature and exhibited marked decreases in glucose metabolism. Such changes were absent when body temperature was maintained during anesthesia

  12. Tramadol as an adjuvant to intravenous regional anesthesia with lignocaine

    International Nuclear Information System (INIS)

    Objective was to assess the effect of different doses of tramadol when added to lignocaine during intravenous regional anesthesia (IVRA). Sixty patients, scheduled for hand surgery under IVRA in King Fahd University Hospital, Al-Khobar, Saudi Arabia from January 2006 to January 2007 were randomly allocated into 3 groups (20 patients each) in a double blind controlled study. All patients received 0.5% lignocaine, 40ml plus 2ml of a study solution containing either isotonic saline (control group), or tramadol 50mg (group T50) or tramadol100mg (group T100). Hemodynamic changes, sensory and motor block onset and recovery time, tourniquet tolerance time, the quality of intraoperative anesthesia and the duration of postoperative analgesia were assessed. All patients 20 in each group completed the study period. Patients who received tramadol had earlier onset of sensory block (5.2+-1.2; 4.9+-1.2 min in the T50; and T100 groups) compared with the control group (7.6+-1.4 min). Patients who received 100mg of tramadol had better tolerance of tourniquet (p=0.011), and less intraoperative fentanyl supplementation (p=0.042). They had also a longer time to the first postoperative analgesic request (p=0.001) compared with the control group. Tramadol 100 mg is a beneficial additive to lignocaine for IVRA since it shortened the onset of sensory block, enhanced the tourniquet tolerance and improved the perioperative analgesia. (author)

  13. Joint Manipulation Under Anesthesia for Arthrofibrosis After Hallux Valgus Surgery.

    Science.gov (United States)

    Feuerstein, Catherine; Weil, Lowell; Weil, Lowell Scott; Klein, Erin E; Argerakis, Nicholas; Fleischer, Adam E

    2016-01-01

    Arthrofibrosis is a known complication of hallux valgus surgery. Joint manipulation under anesthesia has been studied for adhesive capsulitis of the shoulder; however, a paucity of published data exists on the use of this modality in the foot and ankle. The purpose of the present study was to investigate the outcomes of first metatarsophalangeal joint manipulation for arthrofibrosis that occurred as a complication of bunion surgery. The study population consisted of patients attending a single foot and ankle specialty clinic who were evaluated for arthrofibrosis after bunion surgery. Patients who underwent joint manipulation under anesthesia were asked to complete a research visit in which a clinical examination was performed and the presence and severity of joint pain were assessed. A total of 38 patients (34 females, 4 males, 53 feet), with a mean age of 55.7 ± 11.8 (range 30 to 83) years, agreed to participate. The mean follow-up period was 6.5 ± 3.4 (range 1 to 17) years. The visual analog scale scores improved significantly from baseline to the final follow-up visit (baseline 6.5 ± 1.5, range 2 to 10; final follow-up visit 2.3 ± 1.5, range 0 to 6; p mobility and alleviating pain in patients who experience arthrofibrosis after surgical correction of hallux valgus. PMID:26256296

  14. Dopamine uptake dynamics are preserved under isoflurane anesthesia.

    Science.gov (United States)

    Brodnik, Zachary D; España, Rodrigo A

    2015-10-01

    Fast scan cyclic voltammetry is commonly used for measuring the kinetics of dopamine release and uptake. For experiments using an anesthetized preparation, urethane is preferentially used because it does not alter dopamine uptake kinetics compared to freely moving animals. Unfortunately, urethane is highly toxic, can induce premature death during experiments, and cannot be used for recovery surgeries. Isoflurane is an alternative anesthetic that is less toxic than urethane, produces a stable level of anesthesia over extended periods, and is often used for recovery surgeries. Despite these benefits, the effects of isoflurane on dopamine release and uptake have not been directly characterized. In the present studies, we assessed the utility of isoflurane for voltammetry experiments by testing dopamine signaling parameters under baseline conditions, after treatment with the dopamine uptake inhibitor cocaine, and after exposure to increasing concentrations of isoflurane. Our results indicate that surgical levels of isoflurane do not significantly alter terminal mechanisms of dopamine release and uptake over prolonged periods of time. Consequently, we propose that isoflurane is an acceptable anesthetic for voltammetry experiments, which in turn permits the design of studies in which dopamine signaling is examined under anesthesia prior to recovery and subsequent experimentation in the same animals. PMID:26321152

  15. Changes in circulating blood volume following isoflurane or sevoflurane anesthesia.

    Science.gov (United States)

    Hamada, H; Takaori, M; Kimura, K; Fukui, A; Fujita, Y

    1993-07-01

    Changes of circulating blood volume (CB volume) measured by the dual indicator dilution method were observed in 33 chronically instrumented mongrel dogs following either alpha-chloralose-urethane (C group), additive isoflurane (I group) or sevoflurane anesthesia (S group). These anesthetic groups were each divided into two subgroups with regard to respiratory care, namely Cp, Ip and Sp for those with intermittent positive pressure ventilation (six animals per subgroups), and Cs, Is and Ss for those with spontaneous breathing (five animals per subgroups). The CB volume under positive pressure ventilation remained unchanged in the Ip and Sp groups at both 0.5 and 1.0 MAC, and in the Cp group. The CB volume remained essentially unchanged in the Cs and Is groups at both 0.5 or 1.0 MAC, but the plasma volume tended to increase slightly in the Is group at 1.0 MAC. In the Ss group under spontaneous breathing, however, the CB volume increased from 84.4 +/- 7.0 to 91.4 +/- 7.7 at 0.5 MAC, and to 91.4 +/- 10.2 ml.kg(-1) at 1.0 MAC (0.01 < P < 0.05). These increases were caused by an increase in the plasma volume. The above data suggests that a concomitant increase in the venous pressure associated with an increase in the intrathoracic pressure produced by positive pressure ventilation would attenuate changes in the CB volume during sevoflurane anesthesia. PMID:15278818

  16. Of Penguins, Pinnipeds, and Poisons: Anesthesia on Elephant Island.

    Science.gov (United States)

    Firth, Paul G

    2016-07-01

    Although Ernest Shackleton's Endurance Antarctic expedition of 1914 to 1916 is a famous epic of survival, the medical achievements of the two expedition doctors have received little formal examination. Marooned on Elephant Island after the expedition ship sank, Drs. Macklin and McIlroy administered a chloroform anesthetic to crew member Perce Blackborow to amputate his frostbitten toes. As the saturated vapor pressure of chloroform at 0°C is 71.5 mmHg and the minimum alveolar concentration is 0.5% of sea-level atmospheric pressure (3.8 mmHg), it would have been feasible to induce anesthesia at a low temperature. However, given the potentially lethal hazards of a light chloroform anesthetic, an adequate and constant depth of anesthesia was essential. The pharmacokinetics of the volatile anesthetic, administered via the open-drop technique in the frigid environment, would have been unfamiliar to the occasional anesthetist. To facilitate vaporization of the chloroform, the team burned penguin skins and seal blubber under overturned lifeboats to increase the ambient temperature from -0.5° to 26.6°C. Chloroform degrades with heat to chlorine and phosgene, but buildup of these poisonous gases did not occur due to venting of the confined space by the stove chimney. The anesthetic went well, and the patient-and all the ship's crew-survived to return home. PMID:27148920

  17. Rocuronium-Sugammadex in Anesthesia for Electroconvulsive Therapy

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    Nilay Tas

    2016-03-01

    Full Text Available Electroconvulsive therapy (ECT is a form of treatment which is very effective in many psychiatric disorders. The administration of anesthesia plays a positive role in the success of ECT and improves the oxygenation of the body during the process. Succinylcholine, is a depolarizing neuromuscular blocker of choice, the most common agent used to provide muscular relaxation during ECT. Alternative neuromusculer blokers have been used during anesthesia because of contraindications and serious side effects of succinylcholine. Rocuronium is a nondepolarizing neuromuscular blocker with inter-mediate time of action which may be used safely during ECT. Although relatively late onset of action and long half life compared to succinylcholine may seem as drawbacks, the new generation reversing agents like suggamadex have made these disadvantages ignorable. Sugammadex, a new generation neuromuscular blocker reversal agent, not having serious side effects as much as the classic reversals, such as cardiovascular side effects, is playing an important role in anesthesiology practice. In recent years, rocuronium-sugammadex combination is being included in the ECT practice extensively. In this paper, the usability of rocuronium-sugammadex combination as an alternative to succinylcholine has been revised. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(1: 76-84

  18. Nebulized lidocaine and fentanyl before sevoflurane induction of anesthesia in congenital diaphragmatic hernia repair: Prospective double blind randomized study

    OpenAIRE

    Moustafa Abdelaziz Moustafa; Yasser Mohamad Osman

    2015-01-01

    Introduction: Gastric overdistension by mask ventilation during induction of anesthesia in congenital diaphragmatic hernia (CDH) repair may worsen hypoxemia. Topical airway anesthesia may improve the intubating conditions during sevoflurane induction without muscle relaxation. The present study was designed to evaluate the effect of nebulized lidocaine and fentanyl on the intubating conditions without muscle relaxation during sevoflurane induction of anesthesia in infants undergoing CDH re...

  19. Anestesia para colonoscopia: anestesia inhalatoria con sevoflurano frente a anestesia intravenosa con propofol Colonoscopic anesthesia: Inhalatory anesthesia with sevoflurane versus intravenous anesthesia with propofol

    Directory of Open Access Journals (Sweden)

    S. De la Torre Carazo

    2012-03-01

    Full Text Available Introducción: Las exploraciones endoscópicas como la colonoscopia son actualmente cada vez más frecuentes, tanto por prescripción clínica, como para despistaje del cáncer de colon, siendo precisa Anestesia/sedación prácticamente en todos los casos. La técnica más frecuentemente usada es la intravenosa con propofol, en algunos casos no puede realizarse, y se plantea una alternativa inhalatoria. Objetivo: comparación de las características de una técnica habitual con propofol (A y de una inhalatoria con Sevoflurano (B. Sujetos y Método: Se estudian las características de ambas técnicas en dos grupos de 150 pacientes cada uno, valorándose las ventajas de cada una, complicaciones, tolerancia, tiempo de recuperación, aceptación por el endoscopista y el paciente de ambas técnicas. Resultados: en ambas técnicas las complicaciones son muy escasas, el grado de tolerancia es buena/muy buena en el 99% del grupo (A, frente a un 97% del grupo (B. Discusión: Aunque no hemos encontrado publicaciones comparando ambas técnicas en anestesia para colonoscopia, el uso de Sevoflurano ha demostrado características similarmente favorables en pacientes contraindicados para el uso de propofol, siempre que cambiemos el esquema de anestésia intravenosa por inhalatoria. Conclusión: Ambas técnicas son igualmente útiles y seguras, pudiendo emplearse la técnica inhalatoria con Sevoflurano en los pacientes en los que el propofol resulte inadecuado, con iguales prestaciones y versatilidad.Introduction: The exploratory endoscopy and colonoscopy are now increasingly common, both clinical prescription, and for colon cancer screening, needing Anesthesia / sedation in virtually all cases. The most commonly used is intravenous propofol, which in some cases cannot be performed, and an alternative is inhaled. Objective: To compare the characteristics of a standard technique with propofol (A and an inhalation with sevoflurane (B. Subjects and Methods: We

  20. A psychoeducational intervention reduces the need for anesthesia during radiotherapy for young childhood cancer patients

    International Nuclear Information System (INIS)

    Radiotherapy (RT) has become an important treatment modality in pediatric oncology, but its delivery to young children with cancer is challenging and general anesthesia is often needed. To evaluate whether a psychoeducational intervention might reduce the need for anesthesia, 223 consecutive pediatric cancer patients receiving 4141 RT fractions during 244 RT courses between February 1989 and January 2006 were studied. Whereas in 154 RT courses corresponding with 2580 RT fractions patients received no psychoeducational intervention (group A), 90 RT courses respectively 1561 RT fractions were accomplished by using psychoeducational intervention (group B). This tailored psychoeducational intervention in group B included a play program and interactive support by a trained nurse according to age to get familiar with staff, equipment and procedure of radiotherapy. Group A did not differ significantly from group B in age at RT, gender, diagnosis, localization of RT and positioning during RT. Whereas 33 (21.4%) patients in group A got anesthesia, only 8 (8.9%) patients in group B needed anesthesia. The median age of cooperating patients without anesthesia decreased from 3.2 to 2.7 years. In both uni- and multivariate analyses the psychoeducational intervention significantly and independently reduced the need for anesthesia. We conclude that a specifically tailored psychoeducational intervention is able to reduce the need for anesthesia in children undergoing RT for cancer. This results in lower costs and increased cooperation during RT

  1. A comparative study of pain following endodontic treatment under general anesthesia

    Directory of Open Access Journals (Sweden)

    Feizi Ghader

    2015-01-01

    Full Text Available   Background and Aims: Postoperativee endodontic pain is an outstanding problem for dental patients. Therefore, a successful management of endodontic pain has become as one of the main dental objectives. The aim of the present study was to compare the postoperative endodontic pain in patients under general anesthesia versus local anesthesia.   Materials and Methods: For conducting this clinical trial study, 50 patients having mandibular molars candidate for root canal therapy were selected. Twenty-five patients treated under general anesthesia because of their fear, anxiety or gag reflex. Other 25 patients treated under local anesthesia. All teeth were prepared using engine-driven rotary system in a crown-down technique and filled using lateral condensation technique. Heft- parker visual analog scale was used to measure the degree of pain at 6, 12, 24, and 48 hours after the treatment. Mann-Whitney, Chi-square, and T-tests were used to compare the intensity of postoperative pain between the groups.   Results: The mean intensity of postoperative pain in local and general anesthesia groups at 6, 12 and 24 hours had statistically significant difference (P<0.05.   Conclusion: Postoperative pain in patients who treated under general anesthesia was significantly less than the patients who treated under local anesthesia.

  2. Electrical stimulation of the parabrachial nucleus induces reanimation from isoflurane general anesthesia.

    Science.gov (United States)

    Muindi, Fanuel; Kenny, Jonathan D; Taylor, Norman E; Solt, Ken; Wilson, Matthew A; Brown, Emery N; Van Dort, Christa J

    2016-06-01

    Clinically, emergence from general anesthesia is viewed as a passive process where anesthetics are discontinued at the end of surgery and anesthesiologists wait for the drugs to wear off. The mechanisms involved in emergence are not well understood and there are currently no drugs that can actively reverse the state of general anesthesia. An emerging hypothesis states that brain regions that control arousal become active during emergence and are a key part of the return to wakefulness. In this study, we tested the hypothesis that electrical activation of the glutamatergic parabrachial nucleus (PBN) in the brainstem is sufficient to induce reanimation (active emergence) during continuous isoflurane general anesthesia. Using c-Fos immunohistochemistry as a marker of neural activity, we first show a selective increase in active neurons in the PBN during passive emergence from isoflurane anesthesia. We then electrically stimulated the PBN to assess whether it is sufficient to induce reanimation from isoflurane general anesthesia. Stimulation induced behavioral arousal and restoration of the righting reflex during continuous isoflurane general anesthesia. In contrast, stimulation of the nearby central inferior colliculus (CIC) did not restore the righting reflex. Spectral analysis of the electroencephalogram (EEG) revealed that stimulation produced a significant decrease in EEG delta power during PBN stimulation. The results are consistent with the hypothesis that the PBN provides critical arousal input during emergence from isoflurane anesthesia. PMID:26971629

  3. A psychoeducational intervention reduces the need for anesthesia during radiotherapy for young childhood cancer patients

    Directory of Open Access Journals (Sweden)

    Linsenmeier Claudia

    2008-06-01

    Full Text Available Abstract Background Radiotherapy (RT has become an important treatment modality in pediatric oncology, but its delivery to young children with cancer is challenging and general anesthesia is often needed. Methods To evaluate whether a psychoeducational intervention might reduce the need for anesthesia, 223 consecutive pediatric cancer patients receiving 4141 RT fractions during 244 RT courses between February 1989 and January 2006 were studied. Whereas in 154 RT courses corresponding with 2580 RT fractions patients received no psychoeducational intervention (group A, 90 RT courses respectively 1561 RT fractions were accomplished by using psychoeducational intervention (group B. This tailored psychoeducational intervention in group B included a play program and interactive support by a trained nurse according to age to get familiar with staff, equipment and procedure of radiotherapy. Results Group A did not differ significantly from group B in age at RT, gender, diagnosis, localization of RT and positioning during RT. Whereas 33 (21.4% patients in group A got anesthesia, only 8 (8.9% patients in group B needed anesthesia. The median age of cooperating patients without anesthesia decreased from 3.2 to 2.7 years. In both uni- and multivariate analyses the psychoeducational intervention significantly and independently reduced the need for anesthesia. Conclusion We conclude that a specifically tailored psychoeducational intervention is able to reduce the need for anesthesia in children undergoing RT for cancer. This results in lower costs and increased cooperation during RT.

  4. Oxygenation status of cervical carcinomas before and during spinal anesthesia for application of brachytherapy

    International Nuclear Information System (INIS)

    Background and Purpose: To date, no information is available concerning the impact of spinal anesthesia on the oxygenation status of carcinomas of the uterine cervix. The aim of this study was therefore to determine the influence of spinal anesthesia on the oxygenation status of cervical carcinomas. Patients and Methods: In ten patients with cervical carcinoma who received spinal anesthesia for a first application of brachytherapy, intratumoral pO2 measurements (pO2 histography system, Eppendorf-Netheler-Hinz, Hamburg, Germany) were performed. Systemic parameters were documented prior to and during spinal anesthesia. Patients breathed room air spontaneously. For further evaluation, all intratumoral pO2 values were pooled, and overall median pO2 values and fractions of hypoxic pO2 values ≤ 5 mm Hg were calculated. Overall median pO2 values in the subcutis were also calculated. Results: There were no significant changes of systemic parameters, median subcutaneous pO2 values, median intratumoral pO2 values, and the fractions of hypoxic pO2 values ≤ 5 mm Hg in the tumor upon administration of spinal anesthesia. The variability of measured pO2 values increased during spinal anesthesia, although substantial changes in the oxygenation status were only seen in individual cases (n = 2). Conclusion: This study shows for the first time that the oxygenation status of cervical carcinomas, in general, is not influenced by spinal anesthesia prior to application of brachytherapy. To conclude, the data presented suggest that reliable pO2 measurements can be performed under spinal anesthesia. At the same time, since no substantial changes in tumor oxygenation were observed, spinal anesthesia should not affect the O2-related efficacy of high-dose-rate brachytherapy. (orig.)

  5. Comparison of two local anesthesia techniques (conventional & akinosi for inferior alveolar dental nerve

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    Refua Y

    2001-09-01

    Full Text Available Different techniques for local anesthesia are used in the mandible. The purpose of this study"nwas to determine the effects of inferior alveolar dental nerve blocks by comparing the two akinosi and"nconventional techniques. 80 patients (aged 15-60 years old were randomly divided into tow groups for"nextracting the mandibuler posterior teeth by akinosi and conventional techniques. Patients were all"ninjected with 1.8 ml of Lidocaine 2% plus Adernaline j^nnnn .Then the Pain Sensation during injection,"npositive aspiration, beginning time of anesthesia, duration of anesthesia depth of anesthesia, and the anesthesia of soft tissue related to sensory nerves were evaluated. The results showed that the pain sensation in conventional technique was significantly higher than that of akinosi technique. The number of positive aspirations in conventional technique (12,5% was higher than that of akinosi (5% but not significantly different. The long buccal nerve anesthesia in akinosi technique (75% was significantly higher than that of conventional technique. There was no significant difference between the two techniques for the depth of anesthesia. The success rate was 87.5% in conventional technique and 80% in akinosi technique. The average time of lips anesthesia in conventional technique was 3 minutes compared with 4 minutes in akinosi technique, which was not significantly different from each other. However, the beginning time of aneshtesia in tongue was significantly lower in conventional technique. No significant difference in the duration of anesthesia in lips and tonques between the two techniques was observed.

  6. Influence of anesthesia techniques of caesarean section on memory, perception and speech

    Directory of Open Access Journals (Sweden)

    Volkov O.O.

    2014-06-01

    Full Text Available In obstetrics postoperative cognitive dysfunctions may take place after caesarean section and vaginal delivery with poor results both for mother and child. The goal was to study influence of anesthesia techniques following caesarian section on memory, perception and speech. Having agreed with local ethics committee and obtained informed consent depending on anesthesia method, pregnant women were divided into 2 groups: 1st group (n=31 had spinal anesthesia, 2nd group (n=34 – total intravenous anesthesia. Spinal anesthesia: 1.8-2.2 mLs of hyperbaric 0.5% bupivacaine. ТIVА: Thiopental sodium (4 mgs kg-1, succinylcholine (1-1.5 mgs kg-1. Phentanyl (10-5-3 µgs kg-1 hour and Diazepam (10 mgs were used after newborn extraction. We used Luria’s test for memory assessment, perception was studied by test “recognition of time”. Speech was studied by test "name of fingers". Control points: 1 - before the surgery, 2 - in 24h after the caesarian section, 3 - on day 3 after surgery, 4 - at discharge from hospital (5-7th day. The study showed that initially decreased memory level in expectant mothers regressed along with the time after caesarean section. Memory is restored in 3 days after surgery regardless of anesthesia techniques. In spinal anesthesia on 5-7th postoperative day memory level exceeds that of used in total intravenous anesthesia. The perception and speech do not depend on the term of postoperative period. Anesthesia technique does not influence perception and speech restoration after caesarean sections.

  7. Oxygenation status of cervical carcinomas before and during spinal anesthesia for application of brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Weitmann, H.D.; Knocke, T.H.; Poetter, R. [Dept. of Radiotherapy and Radiobiology, Univ. of Vienna, General Hospital of Vienna (Austria); Gustorff, B. [Dept. of Anesthesia and General Intensive Care B, Univ. of Vienna, General Hospital of Vienna (Austria); Vaupel, P. [Inst. of Physiology and Pathophysiology, Univ. of Mainz (Germany)

    2003-09-01

    Background and Purpose: To date, no information is available concerning the impact of spinal anesthesia on the oxygenation status of carcinomas of the uterine cervix. The aim of this study was therefore to determine the influence of spinal anesthesia on the oxygenation status of cervical carcinomas. Patients and Methods: In ten patients with cervical carcinoma who received spinal anesthesia for a first application of brachytherapy, intratumoral pO{sub 2} measurements (pO{sub 2} histography system, Eppendorf-Netheler-Hinz, Hamburg, Germany) were performed. Systemic parameters were documented prior to and during spinal anesthesia. Patients breathed room air spontaneously. For further evaluation, all intratumoral pO{sub 2} values were pooled, and overall median pO{sub 2} values and fractions of hypoxic pO{sub 2} values {<=} 5 mm Hg were calculated. Overall median pO{sub 2} values in the subcutis were also calculated. Results: There were no significant changes of systemic parameters, median subcutaneous pO{sub 2} values, median intratumoral pO{sub 2} values, and the fractions of hypoxic pO{sub 2} values {<=} 5 mm Hg in the tumor upon administration of spinal anesthesia. The variability of measured pO{sub 2} values increased during spinal anesthesia, although substantial changes in the oxygenation status were only seen in individual cases (n = 2). Conclusion: This study shows for the first time that the oxygenation status of cervical carcinomas, in general, is not influenced by spinal anesthesia prior to application of brachytherapy. To conclude, the data presented suggest that reliable pO{sub 2} measurements can be performed under spinal anesthesia. At the same time, since no substantial changes in tumor oxygenation were observed, spinal anesthesia should not affect the O{sub 2}-related efficacy of high-dose-rate brachytherapy. (orig.)

  8. Anesthesia airway management in a patient with upper tracheal tumor.

    Science.gov (United States)

    Wendi, Chen; Zongming, Jiang; Zhonghua, Chen

    2016-08-01

    The main challenge for surgical resection of tumors located at the upper trachea is contemplate formulated plan for providing maximal surgical access to the trachea while ensuring patent airway and adequate oxygenation at the same time. In this report, we describe a patient who presented with an upper tracheal tumor located 3cm from the vocal cord and severe tracheal constriction, occluding tracheal lumen by 90%. Initial ventilation was established by implantation with a supreme laryngeal mask airway. An emergent tracheotomy and distal tracheal intubation were used to combat bleeding and subsequent airway obstruction. Eventually, tracheal tumor resection plus tracheal reconstruction via median sternotomy was successfully conducted under general anesthesia. The whole process is uneventful. PMID:27290961

  9. Variant Inferior Alveolar Nerves and Implications for Local Anesthesia.

    Science.gov (United States)

    Wolf, Kevin T; Brokaw, Everett J; Bell, Andrea; Joy, Anita

    2016-01-01

    A sound knowledge of anatomical variations that could be encountered during surgical procedures is helpful in avoiding surgical complications. The current article details anomalous morphology of inferior alveolar nerves encountered during routine dissection of the craniofacial region in the Gross Anatomy laboratory. We also report variations of the lingual nerves, associated with the inferior alveolar nerves. The variations were documented and a thorough review of literature was carried out. We focus on the variations themselves, and the clinical implications that these variations present. Thorough understanding of variant anatomy of the lingual and inferior alveolar nerves may determine the success of procedural anesthesia, the etiology of pathologic processes, and the avoidance of surgical misadventure. PMID:27269666

  10. EEG under anesthesia--feature extraction with TESPAR.

    Science.gov (United States)

    Moca, Vasile V; Scheller, Bertram; Mureşan, Raul C; Daunderer, Michael; Pipa, Gordon

    2009-09-01

    We investigated the problem of automatic depth of anesthesia (DOA) estimation from electroencephalogram (EEG) recordings. We employed Time Encoded Signal Processing And Recognition (TESPAR), a time-domain signal processing technique, in combination with multi-layer perceptrons to identify DOA levels. The presented system learns to discriminate between five DOA classes assessed by human experts whose judgements were based on EEG mid-latency auditory evoked potentials (MLAEPs) and clinical observations. We found that our system closely mimicked the behavior of the human expert, thus proving the utility of the method. Further analyses on the features extracted by our technique indicated that information related to DOA is mostly distributed across frequency bands and that the presence of high frequencies (> 80 Hz), which reflect mostly muscle activity, is beneficial for DOA detection. PMID:19371961

  11. Effects of unilateral spinal anesthesia with low dose bupivacaine and

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    Nermin Göğüş

    2011-03-01

    Full Text Available Our aim was to compare unilateral spinal anesthesiaproduced by 6 mg hyperbaric bupivacaine or 4mg hyperbaric bupivacaine plus 10 0.05. Although level ofsensory block, and time to reach T12 dermatome werenot different (p>0.05, level of motor block, ambulationtime and time to discharge were significantly longer inGroup I than Group II (p<0.05. Side effects were not differentbetween groups, except more itching in Group II.Conclusion: Spinal anesthesia with using 4 mg hyperbaricbupivacaine+10

  12. Ketamine anesthesia reduces intestinal ischemia/reperfusion injury in rats

    Institute of Scientific and Technical Information of China (English)

    Carlos Roddgo Cámara; Francisco Javier Guzmán; Ernesto Alexis Barrera; Andrés Jesús Cabello; Armando Garcia; Nancy Esthela Fernández; Eloy Caballero; Jesus Ancer

    2008-01-01

    AIM:To investigate the effects of ketamine anesthesia on the motility alterations and tissue injury caused by ischemia/reperfusion in rats.METHODS:Thirty maIe Wistar rats weighing 200-250 g were used.Ischemia was induced by obstructing blood flow in 25% of the total small intestinal length(ileum)with a vascular clamp for 45 min,after which either 60 min or 24 h of reperfusion was allowed.Rats were either anesthetized with pento-barbital sodium(50 mg/kg)or ketamine(100 mg/kg).Control groups received sham surgery,After 60 min of reperfusion,the intestine was examined for mor-phological alterations,and after 24 h intestinal basic electrical rhythm(BER)frequency was calculated,and intestinal transit determined in all groups.RESULTS:The intestinal mucosa in rats that were anesthetized with ketamine showed moderate alterations such as epithelial lifting,while ulceration and hemorrhage was observed in rats that received pento-barbital sodium after 60 min of reperfusion.Quantitative analysis of structural damage using the Chiu scale showed significantly Iess injury in rats that received ketamine than in rats that did not(2.35±1.14 vs 4.58 ±0.50,P<0.0001).The distance traveled by a marker,expressed as percentage of total intestinal length,in rats that received pentobarbital sodium was 20% ± 2% in comparison with 25.9% ±1.64% in rats that received ketamine(P=0.017).BER was not statistically different between groups.CONCLUSION:Our results show that ketamine anesthesia is associated with diminished intestinal iniury and abolishes the intestinal transit delay induced by ischemia/reperfusion.(C)2008 The WJG Press.All rights reserved.

  13. Outcome of Anesthesia and Open Heart Surgery in Pregnant Patients

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    Golamali Mollasadeghi

    2007-06-01

    Full Text Available Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neonatal morbidity and mortality during pregnancy. For a pregnant woman with cardiac disease, the potential inability of the maternal cardiovascular system to contend with normal pregnancy-induced physiologic changes may produce deleterious effects on both mother and fetus. To determine the most frequent surgical indications of maternal and fetal mortality, we studied 15 cases of severe cardiac disease in pregnant women who required cardiac surgical procedures. Methods: In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg or sufentanil (5µ/kg plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile cardio-pulmonary bypass, core temperature was between 28-36 °C, average CBP time was 61.2±22 min, average aortic cross-clamp time was 34.13±14 min, and mean pump pressure was maintained between 65-80 mmHg. Results: Ten patients had severe mitral valve disease (66.6%, three had aortic valve disease (20%, one had subvalvular aortic stenosis (6.7%, and the remaining one had left atrial myxoma (6.7%. There were five fetal deaths (33.3% and one maternal death (6.7%. Conclusion: It seems that open heart surgery in the first trimester is very hazardous for the fetus and may lead to fetal death. If possible, surgery should be carried out in the second trimester of pregnancy. The recommendations are simply guidelines because research data and clinical experience in this area are limited.

  14. Anesthesia management for MitraClip device implantation

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    Harikrishnan Kothandan

    2014-01-01

    Full Text Available Aims and Objectives: Percutaneous MitraClip implantation has been demonstrated as an alternative procedure in high-risk patients with symptomatic severe mitral regurgitation (MR who are not suitable (or denied mitral valve repair/replacement due to excessive co morbidity. The MitraClip implantation was performed under general anesthesia and with 3-dimensional transesophageal echocardiography (TEE and fluoroscopic guidance. Materials and Methods: Peri-operative patient data were extracted from the electronic and paper medical records of 21 patients who underwent MitraClip implantations. Results: Four MitraClip implantation were performed in the catheterization laboratory; remaining 17 were performed in the hybrid operating theatre. In 2 patients, procedure was aborted, in one due to migration of the Chiari network into the left atrium and in second one, the leaflets and chords of the mitral valve torn during clipping resulting in consideration for open surgery. In the remaining 19 patients, MitraClip was implanted and the patients showed acute reduction of severe MR to mild-moderate MR. All the patients had invasive blood pressure monitoring and the initial six patients had central venous catheterization prior to the procedure. Intravenous heparin was administered after the guiding catheter was introduced through the inter-atrial septum and activated clotting time was maintained beyond 250 s throughout the procedure. Protamine was administered at the end of the procedure. All the patients were monitored in the intensive care unit after the procedure. Conclusions: Percutaneous MitraClip implantation is a feasible alternative in high-risk patients with symptomatic severe MR. Anesthesia management requirements are similar to open surgical mitral valve repair or replacement. TEE plays a vital role during the MitraClip implantation.

  15. An anesthesia medication cost scorecard--concepts for individualized feedback.

    Science.gov (United States)

    Malapero, Raymond J; Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Philip, Beverly K; Bates, David W; Urman, Richard D

    2015-05-01

    There is a growing emphasis on both cost containment and better quality health care. The creation of better methods for alerting providers and their departments to the costs associated with patient care is one tool for improving efficiency. Since anesthetic medications used in the OR setting are one easily monitored factor contributing to OR costs, anesthetic cost report cards can be used to assess the cost and, potentially the quality of care provided by each practitioner. An ongoing challenge is the identification of the most effective strategies to control costs, promote cost awareness and at the same time maximize quality. To test the scorecard concept, we utilized existing informatics systems to gather and analyze drug costs for anesthesia providers in the OR. Drug costs were analyzed by medication class for each provider. Individual anesthesiologist's anesthetic costs were collected and compared to the average costs of the overall group and individual trends over time were noted. We presented drug usage data in an electronic report card format. Real-time individual reports can be provided to anesthesiologists to allow for anesthetic cost feedback. Data provided can include number of cases, average case time, total anesthetic medication costs, and average anesthetic cost per case. Also included can be subcategories of pre-medication, antibiotics, hypnotics, local anesthetics, neuromuscular blocking drugs, analgesics, vasopressors, beta-blockers, anti-emetics, volatile anesthetics, and reversal agents. The concept of anesthetic cost report card should be further developed for individual feedback, and could include many other dimensions. Such a report card can be utilized to encourage lower anesthetic costs, quality improvement among anesthesia providers, and for cost containment in the operating room. PMID:25732076

  16. Meningitis tras anestesia espinal Meningitis after a spinal anesthesia

    Directory of Open Access Journals (Sweden)

    A. L. Vázquez-Martínez

    2008-03-01

    Full Text Available La meningitis post-punción es una importante complicación de la anestesia espinal. Describimos el caso de un varón de cuarenta y seis años que ingresó para tratamiento quirúrgico de una hernia umbilical, la cirugía se realizó bajo anestesia intradural. Tras la intervención el paciente comenzó con un cuadro clínico compatible con meningitis, que se confirmó tras examen del líquido cefalorraquídeo. Se trató con antibióticos a pesar de la no identificación de gérmenes, siendo la evolución favorable. El diagnóstico etiológico de una meningitis iatrogénica no siempre es posible, pero siempre debemos tener en cuenta esta posibilidad. En este artículo queremos revisar la situación actual del problema, especialmente la profilaxis y la actitud terapéutica.Post-dural puncture meningitis is a serious complication of spinal anesthesia. We describe the case of a forty six years old male who was admitted for surgical intervention of an umbilical hernia, performed under spinal anesthesia. After surgery the patient developed a clinical syndrome compatible with meningitis, the diagnosis was confirmed by examination of the cerebrospinal fluid. Broad-spectrum antibiotics were started although spinal cultures were negatives, and the patient's clinical course was favourable. The meningitis differential diagnosis may be difficult, but we must think about this possibility. In this case report ,we want to check the present situation, specially the prevention and medical treatment.

  17. Comparing anesthesia with isoflurane and fentanyl/fluanisone/midazolam in a rat model of cardiac arrest

    DEFF Research Database (Denmark)

    Secher, Niels; Malte, Christian Lind; Tønnesen, Else;

    2016-01-01

    BACKGROUND: Only one in ten patients survives cardiac arrest (CA), underscoring the need to improve CA management. Isoflurane has shown cardio- and neuroprotective effects in animal models of ischemia/reperfusion injury. Therefore, beneficial effect of isoflurane should be tested in an experimental...... CA model. We hypothesize that isoflurane anesthesia improves short-term outcome following resuscitation from CA compared with a subcutaneous fentanyl/fluanisone/midazolam anesthesia. METHODS: Male Sprague Dawley rats were randomized to anesthesia with isoflurane (n=11) or fentanyl...... function, all of which are important parameters in CA models....

  18. Anesthesia Dolorosa of Trigeminal Nerve, a Rare Complication of Acoustic Neuroma Surgery

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    Foad Elahi

    2014-01-01

    Full Text Available Anesthesia dolorosa is an uncommon deafferentation pain that can occur after traumatic or surgical injury to the trigeminal nerve. This creates spontaneous pain signals without nociceptive stimuli. Compression of the trigeminal nerve due to acoustic neuromas or other structures near the cerebellopontine angle (CPA can cause trigeminal neuralgia, but the occurrence of anesthesia dolorosa subsequent to acoustic tumor removal has not been described in the medical literature. We report two cases of acoustic neuroma surgery presented with anesthesia dolorosa along the trigeminal nerve distribution. The patients’ pain was managed with multidisciplinary approaches with moderate success.

  19. [Contribution of functional neuroimaging studies to the understanding of the mechanisms of general anesthesia].

    Science.gov (United States)

    Boveroux, P; Bonhomme, V; Kirsch, M; Noirhomme, Q; Ledoux, D; Hans, G; Laureys, S; Luxen, A; Brichant, J F

    2009-01-01

    Since the early beginning of anesthesia, almost 2 centuries ago, ignorance has prevailed regarding the cerebral mechanisms of the loss of consciousness induced by general anesthesia. The recent contribution of functional brain imaging studies has allowed considerable progress in that domain. Similarly, the study of brain function under general anesthesia is currently a major tool for the understanding of conscious phenomena. This functional approach leads to conceptual changes about the functioning brain and may ultimately provide tracks for new treatments and practical applications. All these aspects are reviewed in this paper, at the light of the most recent literature. PMID:20085014

  20. Non-operating Room Anesthesia: The Principles of Patient Assessment and Preparation.

    Science.gov (United States)

    Chang, Beverly; Urman, Richard D

    2016-03-01

    A significant number of anesthetics are performed outside of the operating room (OR). Despite the increased requirement for anesthesia services, the framework to perform the necessary preprocedural anesthesia assessments to optimize patients has not been uniformly developed. Performing anesthesia in non-OR locations poses significant and distinct challenges compared with the procedures in the OR. Anesthesiologists are faced with patients with increasingly complicated comorbidities undergoing novel, complex interventional procedures. With unique training in preoperative triaging, and an expertise in intraoperative and postoperative management of complex patients, anesthesiologists can contribute to greater efficiency and patient safety in the non-OR setting. PMID:26927750

  1. Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery

    Directory of Open Access Journals (Sweden)

    Hiroaki Kawano

    2016-02-01

    Full Text Available BACKGROUND: We investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery. METHODS: Patients were randomly divided into three groups: those maintained with sevoflurane (Group S, n = 42, propofol (Group P, n = 42, or combined propofol and sevoflurane (Group PS, n = 42. We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use, incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24 h after surgery. RESULTS: The number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0-2 h (74%, 76% and 43%, respectively, p = 0.001 and 0-24 h (71%, 76% and 38%, respectively, p < 0.0005. The incidence of nausea at 0-2 h (Group S = 57%, Group P = 26% and Group PS = 21%, p = 0.001 and 0-24 h (Group S = 62%, Group P = 29% and Group PS = 21%, p < 0.0005 was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0-24 h. CONCLUSION: Combined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea. We term this novel method of anesthesia "combined intravenous-volatile anesthesia (CIVA".

  2. Mass-spectrometric online monitoring of metabolism for estimation of adequacy of anesthesia

    Science.gov (United States)

    Elizarov, A. Yu.; Levshankov, A. I.; Faizov, I. I.; Shchegolev, A. V.

    2012-08-01

    The possibility of using a mass-spectrometric method for estimation of the adequacy of anesthesia has been demonstrated. The method is based on online monitoring of metabolism by determining the CO2/O2 concentration ratio during expiration in each breathing cycle, which allows the patient's response to surgical injury in the course of total anesthesia to be evaluated. The proposed method has been clinically tested using an electron-impact ionization mass spectrometer connected to the breathing circuit of an inhalation anesthesia machine. It is shown that, using this technique, the time of the patient's organism response to drug correction of the adequacy of lung ventilation during anesthesia can be monitored online.

  3. Evidence-based management assessment of return on investment from anesthesia information management systems.

    Science.gov (United States)

    O'Sullivan, Cormac T; Dexter, Franklin; Lubarsky, David A; Vigoda, Michael M

    2007-02-01

    A systematic and comprehensive review of the scientific literature revealed 4 evidence-based methods that contribute to a positive return on investment from anesthesia information management systems (AIMS): reducing anesthetic-related drug costs, improving staff scheduling and reducing staffing costs, increasing anesthesia billing and capture of anesthesia-related charges, and increased hospital reimbursement through improved hospital coding. There were common features to these interventions. Whereas an AIMS may be the ideal choice to achieve these cost reductions and revenue increases, alternative existing systems may be satisfactory for the studied applications (i.e., the incremental advantage to the AIMS may be less than predicted from applying each study to each facility). Savings are likely heterogeneous among institutions, making an internal survey using standard accounting methods necessary to perform a valid return on investment analysis. Financial advantages can be marked for the anesthesia providers, although hospitals are more likely to purchase the AIMS. PMID:17304783

  4. Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To observe the advantage of total intravenous anesthesia for transurethral resection of bladder tumor (TURBT). Methods: Sixty ASA Ⅰ-Ⅱ patients undergoing TURBT were randomly assigned to 2 groups. Spinal anesthesia with 0.75% pure bupivacaine (8-12 mg) was applied to patients in Group Ⅰ (n= 30). Patients in Group Ⅱ (n=30) received total intravenous anesthesia with continuous infusion of Propofol and Remifentanil; and a laryngeal mask was used to ensure the airway and ventilation. BP, HR, SPO2 and pertinent side effects were monitored and recorded. Results: The patients in group Ⅱ experienced more stable hemodynamics than those in group Ⅰ. Obturator nerve reflex was observed in 15 (50.0%) patients in Group Ⅰ, but none (0%) in Group Ⅱ (P<0.01). Conclusion: Total intravenous anesthesia with laryngeal mask is a safe, reliable, controllable and simple manual for patient undergoing TURBT.

  5. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension

    DEFF Research Database (Denmark)

    Jørgensen, Thomas; Secher, Niels; Nissen, Peter;

    2010-01-01

    BACKGROUND: Vasopressor agents are used to correct anesthesia-induced hypotension. We describe the effect of phenylephrine and ephedrine on frontal lobe oxygenation (S(c)O(2)) following anesthesia-induced hypotension. METHODS: Following induction of anesthesia by fentanyl (0.15 mg kg(-1)) and...... propofol (2.0 mg kg(-1)), 13 patients received phenylephrine (0.1 mg iv) and 12 patients received ephedrine (10 mg iv) to restore mean arterial pressure (MAP). Heart rate (HR), MAP, stroke volume (SV), cardiac output (CO), and frontal lobe oxygenation (S(c)O(2)) were registered. RESULTS: Induction of...... induced by anesthesia has a negative impact on S(c)O(2) while ephedrine maintains frontal lobe oxygenation potentially related to an increase in CO....

  6. Introduction of the carbon dioxide absorption method with closed circle breathing into anesthesia practice.

    Science.gov (United States)

    Foregger, R

    2000-07-01

    The circle breathing CO2 absorption system for use during acetylene anesthesia was described by Carl Gauss in 1924/1925. The apparatus was manufactured by Drägerwerk of Lübeck. A considerable number of publications on the apparatus employing the closed circle method of CO2 absorption appeared in the medical press soon thereafter. Later apparatus models, also built by Drägerwerk, were adapted for nitrous oxide-oxygen-ether anesthesia and introduced into practice by Paul Sudeck and Helmut Schmidt. Information about all this was transmitted to America through the German medical press, including the Draeger-Hefte. American anesthesia machine manufacturers began to develop closed circle CO2 absorbers several years later. Claims that the circle breathing CO2 absorption method was introduced into anesthesia practice by Brian Sword are not valid. PMID:10969391

  7. Topical anesthesia with eutetic mixture of local anesthetics cream in vasectomy: 2 randomized trials

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Krogh, J; Rye, B;

    1992-01-01

    Two paired randomized trials testing topical anesthesia with a eutetic mixture of local anesthetics (EMLA cream*) in vasectomy were performed. In 1 trial EMLA cream was applied on 1 side of the scrotum, while infiltration anesthesia into the skin and subcutaneous tissue with mepivacaine was used on...... the contralateral side. All but 1 of the 13 patients (p less than 0.05) preferred infiltration anesthesia because of pain as the incision reached the subcutaneous tissue. In the other trial 29 patients received EMLA cream on 1 side of the scrotum before bilateral mepivacaine infiltration. There was...... significantly less pain on the sides with the anesthetic cream (p less than 0.001). Many patients would pay the price of the cream. In conclusion, EMLA cream cannot replace but it can supplement infiltration anesthesia during vasectomy....

  8. Use of Articaine in loco-regional anesthesia for day care surgical procedures

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    Sukhminder Jit Singh Bajwa

    2012-01-01

    Full Text Available The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures.

  9. Cardiovascular consequence of reclining vs. sitting beach-chair body position for induction of anesthesia

    DEFF Research Database (Denmark)

    Larsen, Soren L.; Lyngeraa, Tobias S.; Maschmann, Christian P.; Van Lieshout, Johannes J.; Pott, Frank C.

    2014-01-01

    The sitting beach-chair position is regularly used for shoulder surgery and anesthesia may be induced in that position. We tested the hypothesis that the cardiovascular challenge induced by induction of anesthesia is attenuated if the patient is placed in a reclining beach-chair position....... Anesthesia was induced with propofol in the sitting beach-chair (n = 15) or with the beach-chair tilted backwards to a reclining beach-chair position (n = 15). The last group was stepwise tilted to the sitting beach-chair position prior to surgery. Hypotension was treated with ephedrine. Continuous...... ± 12 vs. 45 ± 15 % reduction from baseline, p = 0.04) and ScO2 (7 ± 6 vs. 1 ± 8% increase from baseline, p = 0.02) and received less ephedrine (mean: 4 vs. 13 mg, p = 0.048). The higher blood pressure and lower need of vasopressor following induction of anesthesia in the reclining compared to the...

  10. Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

    DEFF Research Database (Denmark)

    Garvey, Lene H; Belhage, Bo; Krøigaard, Mogens; Husum, Bent; Malling, Hans-Jørgen; Mosbech, Holger

    2011-01-01

    BACKGROUND:: Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is...... important. METHODS:: A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with......, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). CONCLUSION:: Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence...

  11. Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways

    DEFF Research Database (Denmark)

    Carli, Francesco; Kehlet, Henrik; Baldini, Gabriele; Steel, Andrew; McRae, Karen; Slinger, Peter; Hemmerling, Thomas; Salinas, Francis; Neal, Joseph M.

    2011-01-01

    fast-track methodologies, were identified. The impact of epidural and paravertebral blockade, spinal analgesia, peripheral nerve blocks, and new regional anesthesia techniques on main procedure-specific postoperative outcomes is discussed. Finally, in the last section, implementations required to......Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of...... surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs. In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section...

  12. The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.

    Science.gov (United States)

    Agrifoglio, G; Agus, G B; Bonalumi, F; Costantini, A; Carlesi, R

    1987-01-01

    A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary. PMID:3450753

  13. In vivo metabolic activity of hamster suprachiasmatic nuclei: use of anesthesia

    International Nuclear Information System (INIS)

    In vivo glucose utilization was measured in the suprachiasmatic nuclei (SCN) of Golden hamsters using the 14C-labeled deoxyglucose technique. A circadian rhythm of SCN metabolic activity could be measured in this species, but only during pentobarbital sodium anesthesia when the surrounding background activity of adjacent hypothalamus was suppressed. Both the SCN's metabolic oscillation and its time-keeping ability are resistant to general anesthesia

  14. Effects of deep sedation or general anesthesia on cardiac function in mice undergoing cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Kutschke William

    2009-05-01

    Full Text Available Abstract Background Genetically engineered mouse models of human cardiovascular disease provide an opportunity to understand critical pathophysiological mechanisms. Cardiovascular magnetic resonance (CMR provides precise reproducible assessment of cardiac structure and function, but, in contrast to echocardiography, requires that the animal be immobilized during image acquisition. General anesthetic regimens yield satisfactory images, but have the potential to significantly perturb cardiac function. The purpose of this study was to assess the effects of general anesthesia and a new deep sedation regimen, respectively, on cardiac function in mice as determined by CMR, and to compare them to results obtained in mildly sedated conscious mice by echocardiography. Results In 6 mildly sedated normal conscious mice assessed by echo, heart rate was 615 ± 25 min-1 (mean ± SE and left ventricular ejection fraction (LVEF was 0.94 ± 0.01. In the CMR studies of normal mice, heart rate was slightly lower during deep sedation with morphine/midazolam (583 ± 30 min-1, but the difference was not statistically significant. General anesthesia with 1% inhaled isoflurane significantly depressed heart rate (468 ± 7 min-1, p In mice with ischemic LV failure, ejection fraction measurements were comparable when performed during light sedation, deep sedation, and general anesthesia, respectively. Contrast-to-noise ratios were similar during deep sedation and during general anesthesia, indicating comparable image quality. Left ventricular mass measurements made by CMR during deep sedation were nearly identical to those made during general anesthesia (r2 = 0.99, mean absolute difference Conclusion In mice with normal cardiac function, CMR during deep sedation causes significantly less depression of heart rate and ejection fraction than imaging during general anesthesia with isoflurane. In mice with heart failure, the sedation/anesthesia regimen had no clear impact on

  15. Sudden Sensorineural Hearing Loss after Orthopedic Surgery under Combined Spinal and Epidural Anesthesia

    OpenAIRE

    Ditza Vilhena; Luís Pereira; Delfim Duarte; Nuno Oliveira

    2016-01-01

    Postoperative hearing loss following nonotologic surgery is rare. For patients undergoing subarachnoid anesthesia, the loss of cerebral spinal fluid and hence the drop in intracranial pressure can result in hearing loss and cranial nerve palsy. We report a case in which a patient sustained orthopedic surgery under combined spinal and epidural anesthesia complicated by severe and persistent sensorineural hearing loss. This report is a reminder that postoperative sudden sensorineural hearing lo...

  16. Anesthesia management in a pediatric patient with Dandy-Walker syndrome

    OpenAIRE

    Zeynep Baysal Yıldırım; Salim Akdemir; Vildan Temel; Adnan Tüfek; Feyzi Çelik; Gönül Ölmez Kavak

    2011-01-01

    General anesthesia management of patients with Dandy-Walker syndrome is important since intubation may be difficult due to concomitant anomalies such as hydrocephalus, micrognathia and cleft palate. It should be considered that these patients may require postoperative intensive care support. In this article, anesthesia management of a patient with Dandy-Walker syndrome underwent persistent ventriculo-peritoneal shunt was presented. J Clin Exp Invest 2011; 2 (3): 327-329.

  17. Blood Glucose Alterations in Spinal versus General anesthesia in those undergoing Cesarean Section Delivery

    OpenAIRE

    Alireza Manafi; Habibollah Zakeri; Fatemeh Salahyan; Marzieh Tavassoli; Fahimeh Shekoohi; Roya Kokabi; Sahar Khazforoosh

    2015-01-01

    Introduction: Major body injury or surgery is associated with reproducible metabolic and hormonal responses. Alteration of blood glucose levels is one of the necessary metabolic changes to surgical stress. Surgical techniques and different methods of anesthesia are factors that can help to control and balance the body’s hormones. One of the most effective ways for decline the endocrine-metabolic response is local anesthesia. We conducted this study to compare the measurement of blood glucose ...

  18. INFLUENCE OF TYPE OF ANESTHESIA ON HEMODYNAMIC PARAMETERS AND OUTCOME OF DIALYSIS ARTERIOVENOUS FISTULA OPERATIONS.

    Science.gov (United States)

    Shoshiashvili, V; Tataradze, A; Beglarishvili, L; Managadze, L; Chkhotua, A

    2015-12-01

    The goal of the study was to compare effectiveness of regional and local anesthesia in dialysis arterio-venous fistula (AVF) operations. It was a prospective, randomized study. 103 patients with end stage renal disease underwent AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Duplex sonography evaluation of upper arm vessels was performed pre-operatively and at 1, 3 and 6 months postoperatively. Following parameters were measured on duplex scan: vessel diameter, blood flow rates (PSV and EDV), resistive index (RI) and pulsatility index (PI). Significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group. Time to postoperative pain initiation, need for postoperative pain killers was significantly better in Group II as compared with the Group I. Duration of operation was significantly less in regional as compared with local anesthesia. Postoperative PSV and EDVs were negatively correlated with patient age. The fistula maturation time was positively correlated with age. The vein diameter, postoperative PSV and EDV have been significantly increased in Group I as compared with Group II. The postoperative PI has significantly increased and RI has significantly decreased in Group I as compared with Group II. The total number of dialysis punctures was higher in regional as compared with the local anesthesia. Regional anesthesia provides significantly better analgesia as compared with the local anesthesia in AVF operations. It significantly improves the duplex sonography parameters after AVF formation. It can be a method of choice for some forms of fistulas. PMID:26719545

  19. Propofol is Effective to Depress Fentanyl-Induced Cough during Induction of Anesthesia

    OpenAIRE

    Sedighinejad, Abbas; Naderi Nabi, Bahram; Haghighi, Mohammad; Imantalab, Vali; Hadadi, Sodabe; Reza ERFANI SAYAR; Mirblook, Ahmadreza

    2013-01-01

    Background Various attempts have been made to reduce the incidence of fentanyl-induced cough during anesthesia induction. We hypothesized that an appropriate dose of propofol might suppress fentanyl-induced cough. Objectives A study had been designed to observe the effects of propofol on a fentanyl-induced cough during anesthesia induction. Patients and Methods We performed a randomized, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous propofol (20 ...

  20. Local Anesthesia in Cataract Surgery-A Comparison of Different Methods

    Institute of Scientific and Technical Information of China (English)

    Nolan; J; Aziz; M; Ahmad; M; Shehata; M; Iqbal; F

    1993-01-01

    Seven groups of thirty patients undergoing cataract extraction under local anesthesia were each given different combinations of local anesthesia. These varied from a maximum approach using supra-orbital, infra-orbital and facial blocks with Hyalase, orbital compression and pre-operative Acetazolamide down to a minimum group receiving purely an infra- orbital and supra-orbital block with a Ugnocaine/Bupivacaine mixture. There was no significant difference in local analgesia or in the complication rates b...

  1. Surgical treatment of varicose vein using the tumescent technique of local anesthesia

    OpenAIRE

    Bjelanović Zoran; Leković Ivan; Drašković Miroljub; Mišović Sidor; Veljović Milić

    2011-01-01

    Background/Aim. Tumescent local anesthesia (TLA) is a technique for local and regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large amounts of a diluted solution of local anesthetic. This technique is applied in plastic surgery, liposuction as well as in dermatology for the entire series of dermatocosmetic procedures. The purpose of this study was to determine efficiency of surgical treatment of varicose vein using TLA as an alternative method to a conventio...

  2. [Changes in the cerebral hemodynamics during Rohypnol anesthesia in neurosurgical patients].

    Science.gov (United States)

    Gribkov, A V; Bakunin, L M; Rufova, N Iu

    1994-01-01

    Intracranial pressure, cerebral perfusion pressure, and intracerebral blood volume changes were observed in 43 patients with volumetric intracranial processes (intracranial hematomas, tumors) during general rohypnol anesthesia. Intracranial and cerebral perfusion pressures were found to correlate with intracerebral blood volume. Rohypnol anesthesia decreased intracranial pressure by 25% due to reduced arterial blood influx into the head, mechanisms responsible for autoregulation of cerebral circulation being intact. PMID:8209591

  3. The Effects of Epidural Top-Up Technique with Serum Physiological On Unilateral Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    İlkay Cömert

    2006-01-01

    Full Text Available This study was designed to investigate the influence of saline injections as epidural top-up on the sensory block duration, quality and hemodynamic effects of unilateral spinal anesthesia. The cases from ASA I-Il containing of 18-65 age group were randomly separated into three groups. For the purpose of unilateral spinal anesthesia, 6 mg 0.5% ‘heavy’ bupivacaine and for the purpose of epidural top-up, 10 mL saline were applied to the each patients of the groups. The study protocol was designed as:Ist group: Coming after the epidural catheter installation, unilateral spinal anesthesia was applied (n=20.IInd group: At first, unilateral spinal anesthesia was applied and after one minute, epidural top-up was done via the pre-installed epidural catheter (n=20.IIIrd group: At first the epidural catheter was installed and epidural top-up was applied. After one minute, unilateral spinal anesthesia was fulfilled (n=2O. Starting from the pre-anesthesic period, the hemodynamic data and following the anesthesia, the sensorial and motor block levels were recorded and evaluated.As the outcome of the inter-groups comparison of heart rate and mean arterial pressure, a statistically note-worthy differance was not determined; statistically significant but clinically acceptable hemodynamic changes were observed in intra-group evaluations, when the data was compared with control levels. The sensorial block levels were significantly higher in group II and significantly lower in group III.The application of 10 mL saline via epidural catheter 1 minute after the unilateral spinal anesthesia and remaining the patient leaning on the side of the extremity to be operated for 15 minutes improves the sensory block level of unilateral spinal anesthesia. It is determined that, for the lower extremity surgical operations with 1-1.5 hour estimated period, this method alone can be a worthwhile alternative.

  4. A revisit of transthecal digital block and traditional digital block for anesthesia of the finger

    OpenAIRE

    Mohammad Dehghani; Arsalan Mahmoodian

    2007-01-01

    BACKGROUND: Finger injuries are very common and the majority can be treated under digital block anesthesia. Traditional digital block is one of the most commonly performed blocks by care providers in several medical fields. There is another less known method, transthecal (Pulley) block, in which local anesthesia is injected into the flexor tendon sheath.
    METHODS: A randomized clinical trial was performed to compare the tran...

  5. Comparison of Hyperbaric Levobupivacaine with Hyperbaric Bupivacaine in Unilateral Inguinal Hernia Operations Performed Under Spinal Anesthesia

    OpenAIRE

    Orhan Gozaydin; Guven Gulen; Guneri Atalan; Mehmet Kaydul

    2014-01-01

    Aim: The aim of this study was to compare hyperbaric bupivacaine used for spinal anesthesia in the patients with inguinal hernia with the same amount of hyperbaric levobupivacaine. Materials and methods: Forty ASAI-II patients, with a unilateral inguinal hernia operation planned under spinal anesthesia by the surgeon, were included in the study. It was planned that the study be prospective and double-blind. The patients were allocated into two groups, each of which had 20 persons allocated...

  6. Recovery Following Desflurane Versus Sevoflurane Anesthesia for Outpatient Urologic Surgery in Elderly Females

    OpenAIRE

    Green, Michael S.; Green, Parmis; Neubert, Lee; Voralu, Kirtanaa; Saththasivam, Poovendran; Mychaskiw, George

    2015-01-01

    Background: An unresolved question is the time required for the ability to return to complex tasks following anesthesia. Objectives: This study aims to characterize the severity and duration of cognitive impairment following sevoflurane or desfluane anesthesia after brief surgery using tests of cognitive ability to objectively testing performance. Patients and Methods: This study is a double blinded randomized controlled trial. Patients were randomized to receive either a desflurane or sevofl...

  7. Effect of Passive Smoke Exposure on General Anesthesia for Pediatric Dental Patients

    OpenAIRE

    Thikkurissy, S; Crawford, Bethany; Groner, Judith; Stewart, Roderick; Smiley, Megann K.

    2012-01-01

    The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months–12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regardin...

  8. Behavioral and emotional effects of repeated general anesthesia in young children

    OpenAIRE

    Bakri, Mohamed H.; Ismail, Eman A.; Ali, Mohamed S.; Elsedfy, Ghada O.; Sayed, Taher A.; Ahmed Ibrahim

    2015-01-01

    Background: Preclinical and clinical data suggest the possibility of neurotoxicity following exposure of young children to general anesthetics with subsequent behavioral disturbances. The aim of the study was to determine the overall effect of repeated general anesthesia on behavior and emotions of young children aged 1½-5 years old, compared to healthy children. Materials and Methods: Thirty-five children underwent repeated anesthesia and surgery were matched with the same number of healthy ...

  9. Evaluation of the Adequacy of General Anesthesia in Cesarean Section by Bispectral Index

    OpenAIRE

    Sayed Mohammad Reza Hadavi; Elaheh Allahyary; Saman Asadi

    2013-01-01

    Background: Awareness and recall, though not common, are the major hazards of general anesthesia, especially in Cesarean section (C/S) because of the absence of benzodiazepine and opioids for a significant time during anesthesia. In this study, the Bispectral Index (BIS), end-tidal isoflurane, and hemodynamic parameters were examined to evaluate the depth of the routine general anesthetic technique in C/S. Methods: This study was carried out on 60 parturient patients undergoing elective C/...

  10. Cataract surgery under topical anesthesia: Gender-based study of pain experience

    OpenAIRE

    Sanjiv Kumar Gupta; Ajay Kumar; Swati Agarwal

    2010-01-01

    Background : Pain perception, expression, tolerance, and the healthcare provider′s evaluation and management of pain are affected by the gender of the patient. To the best of our knowledge, there is lack of gender-based evaluation of pain during cataract surgery under topical anesthesia. Aims : This study has been initiated to evaluate and determine pain experience during cataract surgery under topical anesthesia and to study the gender-based differences of the same. Settings and Desi...

  11. The effect of early ambulation on the incidence of neurological complication after spinal anesthesia with lidocaine

    OpenAIRE

    Reihanak Talakoub; Mohammad Golparvar; Rezvan Arshi

    2015-01-01

    Background: Transient neurological symptoms (TNS), was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%. Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithoto...

  12. Stress of anesthesia with M.S. 222 and Benzocaine in Rainbow Trout (Salmo gairdneri)

    Science.gov (United States)

    Wedemeyer, Gary

    1970-01-01

    Rainbow trout (Salmo gairdneri) anesthetized with M.S. 222 for periods up to 12 min experience interrenal ascorbate depletion, uremia, and moderate hypercholesterolemia. Anesthesia with neutralized M.S. 222 (pH 7) or benzocaine prevented these changes and significantly reduced the variability in plasma glucose, cholesterol, and cortisol, indicating that the stress of anesthesia with M.S. 222 is due to the low pK of the sulfonic acid moiety.

  13. STUDY OF INJECTION TRAMADOL AS ADDITIVE IN INTRAVENOUS REGIONAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Rajesh

    2015-10-01

    Full Text Available Now a days IVRA is developed with use of double tourniquet and additive drugs like opioids, NSAIDS , muscle relaxants etc ., to minimize the intraoperative discomfort of surgery and tourniquet pain. Many additives can take care of the post - operative pain. Each additive has its own pros and cons. Tramadol is a synthetic opioid analgesic having additional local anesthetic propert y and effect in neurotransmitter reuptake. With this background we studied the injection Tramadol 50mg as additive in IVRA against control group. METHODOLOGY : All the selected patients are from ASA Grade 1 and 2 for surgical procedure of upper limb. We hav e excluded the cases which are contraindicated for tourniquet and patients who are uncooperative and allergic to drug used for study. All 50 patients are divided in two groups. Group 1 - 25 patients who receive Intravenous Regional Anesthesia with injection lignocaine 0.5% 40cc volume. Group 2 - 25 patients who receive Intravenous Regional Anesthesia with injection Tramadol 50mgand injection lignocaine 0.5% total40ccvolume. After the drug is loaded in venous compartment sensory blocked is assessed at the interva l of one min. by blunt needle pin pricks in all dermatome segments by using a 3 - point scale: 0 = normal sensation, 1 = loss of sensation of pin prick ( A nalgesia, and 2 = loss of sensation of touch ( A nesthesia. Motor block is assessed at the interval of t wo min. Motor block was determined according to the modified Bromage scale. It is on 3 point assessment i.e. , thumb abduction (Radial nerve, thumb adduction ( U lnar nerve, thumb opposition ( M edian nerve, and flexion of elbow ( M usculocutaneous nerve OBSE RVATIONS : we observed onset of sensory blockade, onset of motor blockade , intraoperative discomfort, postoperative analgesia and postoperative nausea vomiting. Onset of sensory blockade is significantly rapid in group2 ( I njection lignocaine + injection Tramadol group (p - 0.00001 whereas there

  14. General anesthesia-associatedDNA damage in peripheral blood mononuclear cells of surgical patients

    Institute of Scientific and Technical Information of China (English)

    Wang Haiyan; Zhou Qi; Fu Huo

    2011-01-01

    Objective:To evaluate retrospectively the effect of general anesthesia onDNA damage in the blood mononuclear cells (PBMCs) of surgical patients in order to provide evidence for a better nursing care during the procedure.Methods: Clinical charts of76 patients who underwent operation under general anesthesia and76 healthy control subjects with documented results of DNA damage extent inPBMCs from the single-cell gel electrophoresis(SCGE) or comet assay and serum contents of superoxide dismutase(SOD) and malondialdehyde(MDA)from biochemical analyses were reviewed. The percentage of comet PBMCs and tailDNAand serum contents of SOD and MAD were analyzed by student t-test.Results: Compared with healthy control subjects, generally anesthetized surgical patients had significantly higher % cometPBMCs and % tail DNA(P<0.05) and significantly lower serum concentrations ofSOD (P<0.05) and significantly higher serum concentrations ofMAD (P<0.05). Compared with levels before general anesthesia in surgical patients, % cometPBMCs, % tailDNA, and serum levels ofMADwere significantly higher (P<0.05 or0.01), and serum levels ofSOD were significantly lower (P<0.05), after general anesthesia.Conclusions: General anesthesia during surgery causes a certain degree of hypoxia and PBMC damage. Particular attention should be paid to monitoring and maintenance of blood oxygen saturation in patients undergoing surgery under general anesthesia.

  15. Endoscopic Carpal Tunnel Release using a modified application technique of local anesthesia: safety and effectiveness

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    Al-Khayat Jehad

    2008-04-01

    Full Text Available Abstract Background Local anesthesia is widely used for open carpal tunnel release. However, injection of local anesthesia as described by Altissimi and Mancini (1988 can interfere with endoscopic carpal tunnel release, by increasing the bulk of synovial layers and consequently result in worsening of the view. Purpose The purpose of this study was to evaluate the safety, efficacy using modified technique for application of local anesthesia. Methods 33 patients suffering from gradual increasing symptoms of carpal tunnel syndrome. The patients were also asked to evaluate the pain associated with injection as well as tourniquet during surgery using Visual Analogue Scale (VAS (ranging from 0 = no pain to 10 = maximum pain. Results One patient required additionally local anesthesia because of mild pain in the hand. The tourniquet was inflated for 13.00 (2.8 min. The pain score related to injection was 2.5 (0.8 and to tourniquet was 3.6 (0.9. Inflation of the tourniquet was well tolerated by all patients. Postoperative neurological sensory and motor deficits related to surgery and local blocks were not occurred. Conclusion Endoscopic release of the carpal tunnel syndrome in local anesthesia is effective, well tolerated and safe. This kind of application of local anesthesia did not reduce visibility.

  16. A Comparison of Satisfaction; Spinal versus General Anesthesia for Cesarean Section

    International Nuclear Information System (INIS)

    Objective: To compare the patients satisfaction with spinal and general anesthesia after cesarean section at CMH Lahore. Study Design: Randomized controlled trials. Study Setting: The study was conducted at the department of Obstetrics and Gynaecology combined military Hospital, Lahore, for 6 months from July to Dec 2011. Patients and Methods: Total 70 patients were included in the study and randomly divided into two groups of 35 each using random numbers table. All patients between ages of 20-40 years admitted for elective cesarean section and presented for following up at day 5-7 who never had any type of anesthesia in the past. There included in the study patients with complaints of migraine, low backaches, positive history or any other medical disorder were excluded from the study. Results: A total number of patients included were 70. Out of these selected patients, 35 procedures were carried out under spinal anesthesia and 35 under general anesthesia. Insignificant difference was found in satisfaction level of both the groups (p=0.220). There is significant difference for the future choice between two groups (p<0.001). Conclusion: Spinal anesthesia provides equal satisfaction for patients of cesarean section than general anesthesia. (author)

  17. Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-Pressure Pneumoperitoneum - Prospective Study of 150 Cases

    Directory of Open Access Journals (Sweden)

    Sunder Goyal

    2012-08-01

    Materials and Methods: In a private rural medical college, 150 patients were selected prospectively for laparoscopic cholecystectomy, under low-pressure (8mmHg pneumoperitoneum and under spinal anesthesia over a span of one and a half years. Injection bupivacaine (0.5% was used for spinal anesthesia. All ports were made in a head-down position to avoid hypotension. Shoulder pain was managed by reassurance as well as by diverting the attention and sedation in a few cases. Results: We successfully performed the operations in 145 patients without major complications. Spinal anesthesia was converted to general anesthesia in five patients due to severe shoulder pain. Age varied between 21 and 75 years. Duration of operation time (skin to skin was between 40 and 80 minutes. Twenty-nine patients complained of right shoulder pain. Most of them were managed by reassurance from the anesthetist and a few needed an injection of fentanyl along with midazolam. Conclusion: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum is feasible and safe under spinal anesthesia. Incidence of postoperative shoulder pain and complications are comparable with laparoscopic cholecystectomy under general anesthesia. [Arch Clin Exp Surg 2012; 1(4.000: 224-228

  18. Comparison of unilateral spinal and continous spinal anesthesia for hip surgery in elderly patients

    Directory of Open Access Journals (Sweden)

    Leyla T Kilinc

    2013-01-01

    Full Text Available Background: Continous spinal anesthesia (CSA and frequently unilateral spinal anesthesia (USpA are usually preferred for lower extremity surgeries. In this study, we aimed to compare the effects of these anesthetic techniques, on hemodynamic parameters, quality of anesthesia and complications in elderly patients undergoing hip surgeries. Methods: Forty patients aged 65 years and older, assigned to receive either CSA or USpA with 7.5 mg (1.5 cc 0.5% hyperbaric bupivacaine initially. In CSA group, additional doses of 2.5 mg bupivacaine were applied until sensory block reach to T 10 . Maximum sensorial block level, time to reach the level of T 10 (defined as onset time and to regress to T 12 , hemodynamic parameters and ephedrine requirements were recorded peroperatively and during 2 h postoperatively. Results: Hemodynamic parameters, ephedrine requirements and regression of sensory block by two levels were similar in two groups. The onset time of anesthesia was significantly longer in USpA group than CSA group. Neuraxial anesthesia had to be converted to general anesthesia in 5 patients (25% in CSA group and 1 patient (5% in USpA group. Conclusions: We conclude that both USpA and CSA techniques have similar effects in elderly high risk patients. On the other hand, USpA is more preferable for surgeries with shorter durations due to its low cost and high success rate.

  19. Comparison of topical and infiltration anesthesia for orthodontic mini-implant placement

    Directory of Open Access Journals (Sweden)

    Matheus Miotello Valieri

    2014-04-01

    Full Text Available Objective: To compare the acceptability and effectiveness of topical and infiltration anesthesia for placement of mini-implants used as temporary anchorage devices. Methods: The sample comprised 40 patients, 17 males and 23 females, whose mean age was 26 years old and who were all undergoing orthodontic treatment and in need for anchorage reinforcement. Mini-implants were bilaterally placed in the maxilla of all individuals, with infiltration anesthesia on one side and topical anesthesia on the other. These 40 patients completed two questionnaires, one before and another after mini-implant placement and pain was measured through a visual analog scale (VAS. The data collected were analyzed using descriptive statistics and the measurements of pain were compared by means of the non-parametric test of Mann-Whitney. Results: It was found that 60% of patients felt more comfortable with the use of topical anesthesia for mini-implant placement; 72.5% of patients described the occurrence of pressure during placement of the anchorage device as the most unpleasant sensation of the entire process; 62.5% of patients felt more pain with the use of topical anesthesia. Conclusion: It was concluded that patients had less pain with the use of infiltration anesthesia, and also preferred this type of anesthetic.

  20. The efficiency of different adjunct techniques for regional anesthesia.

    Science.gov (United States)

    Pongraweewan, Orawan; Lertakyamanee, Jariya; Luangnateethep, Ungkana; Pooviboonsuk, Prakorb; Nanthaniran, Mayuree; Sathanasaowapak, Pariyacha; Chainchop, Petcharee

    2005-03-01

    In the present prospective, randomized controlled trial, 110 unpremedicated patients undergoing orthopedic surgery under regional anesthesia were randomly divided into 5 groups, with 22 patients in each. During the operation, group 1 listened to a pre-recorded explanation and music, group 2 listened to a subliminal sound, group 3 received propofol by patient-controlled sedation (PCS), group 4 received intravenous midazolam, and group 5 was the control group. Patients in the midazolam group were significantly more sedated than the control group at 1 hr into the operation. The group that listened to an explanation and music were significantly less satisfied than the propofol group at the end of the operation and 30 min. postoperatively. An incremental cost-effectiveness ratio showed that if explanation and music are used instead of propofol it would save 299.53 baht per patient, but the patient satisfaction score will be 17.26 points lower than if the more expensive drug is used. PMID:15962646

  1. Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

    Science.gov (United States)

    Ramazani, Nahid

    2016-01-01

    Context Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. Evidence Acquisition A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Results Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Conclusions Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes. PMID:27307962

  2. Environmental and occupational hazards of the anesthesia workplace

    International Nuclear Information System (INIS)

    Our present state of research and knowledge strongly suggests that the volatile agents, halothane, enflurane and isoflurane, present only a minimal threat to our environment. Nitrous oxide, however, has ozone-depleting potential as well as a greenhouse gas effect which may contribute much to the problem of global warming over the next few decades. Release of anesthetic gases into the atmosphere presents a small problem in contrast to other sources of ozone-depleting chemicals and greenhouse gases, but anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by reevaluating the use of N2O, using low flows of gases and exploring the use of activated charcoal absorption in the scavenging systems to remove volatile agents. Infectious waste, radiation, lasers, chemicals and waste gases pose possible occupational health hazards in the operating room. Each of us should play a critical role in monitoring harmful substances and should actively practice techniques which would lessen the hazards. We should be cognizant of the fact that sources not yet introduced into our environment may have adverse effects on our health and that vigilance and education are key factors in maintaining a safe work environment.24 references

  3. Radiologically-placed venous ports in children under venous anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Joo Yeon; Jeon, Ung Bae; Choo, Ki Seok; Hwang, Jae Yeon; Kim, Yong Woo; Lee, Yun Jin; Nam, Sang Ool; Lim, Young Tak [Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2015-02-15

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  4. Major themes for 2012 in cardiovascular anesthesia and intensive care.

    Science.gov (United States)

    Riha, H; Patel, P; Al-Ghofaily, L; Valentine, E; Sophocles, A; Augoustides, J G T

    2013-01-01

    There was major progress through 2012 in cardiovascular anesthesia and intensive care. Although recent meta-analysis has supported prophylactic steroid therapy in adult cardiac surgery, a large Dutch multicenter trial found no outcome advantage with dexamethasone. A second large randomized trial is currently testing the outcome effects of methyprednisolone in this setting. Due to calibration drift, the logistic EuroSCORE has recently been recalibrated. Despite this model revision, EuroSCORE II still overestimates mortality after transcatheter aortic valve implantation. It is likely that a specific perioperative risk model will be developed for this unique patient population. Recent global consensus has prioritized 12 non-surgical interventions that merit further study for reducing mortality after surgery. There is currently a paradigm shift in the conduct of adult aortic arch repair. Recent advances have facilitated aortic arch reconstruction with routine antegrade cerebral perfusion at mild-to-moderate hypothermia. Further integration of hybrid endovascular techniques may allow future aortic arch repair without hypothermia or circulatory arrest. These advances will likely further improve patient outcomes. PMID:23734284

  5. Radiologically-placed venous ports in children under venous anesthesia

    International Nuclear Information System (INIS)

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  6. Parameters of anesthesia/sedation in children receiving radiotherapy

    International Nuclear Information System (INIS)

    Previous reports establish low risk of complications in pediatric treatments under anesthesia/sedation (A/S) in the outpatient setting. Here, we present our institutional experience with A/S by age and gender in children receiving daily proton RT. After Institutional Review Board approval, we reviewed our center’s records between 9/9/2004 and 6/30/2013 with respect to age and gender of A/S requirement in our pediatric patients (defined as patients ≤18 years of age). Of 390 patients treated in this era, 182 were girls. Children aged ≤3 invariably required A/S; and by age 7–8, approximately half of patients do not. For pediatric patients ≥ 12 years of age, approximately 10% may require A/S for different reasons. There was no difference by gender. Beyond age 3, the requirement for A/S decreases in an age-dependent fashion, with a small cadre of older children having difficulty enough with sustained immobilization that A/S is necessary. In our experience, there is no difference in A/S requirement by gender

  7. [Atelectasis in general anesthesia and alveolar recruitment strategies].

    Science.gov (United States)

    Martínez, G; Cruz, P

    2008-10-01

    Atelectasis occurs in most patients during general anesthesia and is the main cause of hypoxemia. The objective of this review is to examine the causes and diagnosis of atelectasis and the different strategies for reducing or preventing this complication and improving oxygenation. Pulmonary atelectasis is mainly caused by 3 factors: compression, gas absorption, and lack of surfactant. Compression and gas absorption are, however, the 2 most commonly implicated factors. Lung collapse is accentuated if pure oxygen is inhaled during induction or if the patient is morbidly obese. Laparoscopic, thoracic, and upper abdominal interventions also carry risk of lung collapse. Various techniques may be used to prevent atelectasis or to reopen collapsed lung tissue. These include using positive end-expiratory pressure or a high tidal volume-thus providing a higher airway pressure (vital capacity maneuver)-or both in combination. Alveolar recruitment strategies have been tried in bariatric surgery, single-lung ventilation, laparoscopy, and adult respiratory distress syndrome. Their application has reduced or prevented atelectasis, thereby reducing postoperative pulmonary complications. PMID:18982787

  8. Passive narcosis for anesthesia induction in cotton rats (Sigmodon hispidus).

    Science.gov (United States)

    Hanson, Jarod M; Anderson, Lydia J; Williams, Colin M; Jorquera, Patricia; Tripp, Ralph A

    2016-08-23

    Cotton rats (Sigmodon hispidus) are widely used as animal models for infectious disease and immunological research. They emulate many aspects of human disease pathogenesis, and the introduction of cotton rat-specific immunological reagents, cell lines and sequencing of relevant genes have all helped to increase the popularity of this disease model. However, the use of cotton rats is problematic owing to their propensity for aggressive responses when handled, which can lead to escape, increased stress to the animals, and bites to staff. When cotton rats are co-housed, which is recommended under current social housing guidelines, these risks are increased. Here, we describe a method of isoflurane anesthesia induction in the home cage that reduces the risk of animal escape, minimizes stress during induction, and provides additional safety for staff. The method uses inexpensive materials that are widely available and can be easily disinfected. Our method also eliminates the need for expensive and cumbersome machines traditionally used with anesthetic chambers, and uses a minimal amount of inhalant anesthetic, saving resources and protecting staff from inhalation of leaked gas. PMID:27551803

  9. [Anesthesia unrelated triggering of a fatal malignant hyperthermia crisis].

    Science.gov (United States)

    Olthoff, D; Vonderlind, C

    1997-12-01

    For incidents of malignant hyperthermia (MH) outside the hospital, a high number of unrecorded cases must be reckoned with because of an insufficient knowledge of emergency services and poor identification and documentation that make it impossible to classify acute situations under the diagnosis of malignant hyperthermia crisis. As a result, there are no statistical data in this field, and only case reports with a broad spectrum of suspected trigger mechanisms have been published. The case described in this report is a proved example of a non-anesthesia-related triggering of MH in a 21-year-old man who had had an anesthetic-induced MH manifestation in childhood, which was confirmed with an in vitro contracture test. After visiting a restaurant, he became unconscious and convulsive after consuming a high level of alcohol (2.9/1000). The first cardiocirculatory arrest occurred directly before hospitalization. After admission, the patient showed a full-blown MH episode whose subsequent fatality was unavoidable in spite of adapted and optimal therapy. Suspected trigger mechanisms seem to be multifactoral (excessive alcohol consumption, over-heating, mental stress) as a forensic investigation did not point to any particular signs of typical trigger substances. The case demonstrates again that an MH attack might be triggered under certain non-anaesthesia-related situations. For patients with an MH disposition, additional information on their behavior outside the hospital is required. PMID:9451492

  10. Comparison of the effects of inhalational anesthesia with desflurane and total intravenous anesthesia on cardiac biomarkers after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Poonam Malhotra Kapoor

    2015-01-01

    Full Text Available Objective (s: The aim of this study was to compare the effects of using inhalational anesthesia with desflurane with that of a total intravenous (iv anesthetic technique using midazolam-fentanyl-propofol on the release of cardiac biomarkers after aortic valve replacement (AVR for aortic stenosis (AS. The specific objectives included (a determination of the levels of ischemia-modified albumin (IMA and cardiac troponin I (cTnI as markers of myocardial injury, (b effect on mortality, morbidity, duration of mechanical ventilation, length of Intensive Care Unit (ICU and hospital stay, incidence of arrhythmias, pacing, cardioversion, urine output, and serum creatinine. Methodology and Design: Prospective randomized clinical study. Setting: Operation room of a cardiac surgery center of a tertiary teaching hospital. Participants: Seventy-six patients in New York Heart Association classification II to III presenting electively for AVR for severe symptomatic AS. Interventions: Patients included in the study were randomized into two groups and subjected to either a desflurane-fentanyl based technique or total IV anesthesia (TIVA. Blood samples were drawn at preordained intervals to determine the levels of IMA, cTnI, and serum creatinine. Measurements and Main Results: The IMA and cTnI levels were not found to be significantly different between both the study groups. Patients in the desflurane group were found to had significantly lower ICU and hospital stays and duration of postoperative mechanical ventilation as compared to those in the TIVA group. There was no difference found in mean heart rate, urine output, serum creatinine, incidence of arrhythmias, need for cardioversion, and 30-day mortality between both groups. The patients in the TIVA group had higher mean arterial pressures on weaning off cardiopulmonary bypass as well as postoperatively in the ICU and recorded lower inotrope usage. Conclusion: The result of our study remains ambiguous regarding

  11. Comparative study of patients undergoing check curettage for first trimester incomplete and inevitable abortion under paracervical block versus no anesthesia

    Directory of Open Access Journals (Sweden)

    Nihita Pandey

    2016-03-01

    Conclusions: The mean pain scores of both the groups were on the lower spectrum of the pain scale with no difference in demand for higher anesthesia. In primary set ups where facilities of anesthesia are not available, curettage can be performed safely without anesthesia, which can prove to be life-saving. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 629-632

  12. Effect of Oral Midazolam Premedication on Children’s Co-operation Before General Anesthesia in Pediatric Dentistry

    OpenAIRE

    Nasser Kaviani; Mina Shahtusi; Maryam Haj Norousali Tehrani; Sara Nazari

    2014-01-01

    Statement of the Problem: Premedication is expedient in reducing the psychological trauma from recalling the unpleasant pre-anesthetic phases, hence, inducing a trouble-free anesthesia. Purpose: This study aimed to determine the effectiveness of oral midazolam in co-operation of the subjects before general anesthesia and in recalling the pre-anesthetic phases, performed on children candidate for dental treatment under general anesthesia. Materials and Method: In this prospective clini...

  13. Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study

    OpenAIRE

    OUCHI, Kentaro; SUGIYAMA, Kazuna

    2015-01-01

    Background We investigated the impact of the type of neurological disorder on the required propofol dose for anesthesia and the time to emerge from anesthesia during dental treatment in patients with autism (AU), cerebral palsy (CP), and intellectual disability (ID), some of whom also had epilepsy. Methods We studied 224 patients with a neurological disorder who underwent dental treatment under intravenous general anesthesia. Patients were categorized according to neurological disorder (AU, C...

  14. Closed-loop control of anesthesia using bispectral index - Performance assessment in patients undergoing major orthopedic surgey under combined general and regional anesthesia

    NARCIS (Netherlands)

    Absalom, AR; Sutcliffe, N; Kenny, GN

    2002-01-01

    Background: The Bispectral Index (BIS) is an electroencephalogram-derived measure of anesthetic depth. A closed-loop anesthesia system was built using BIS as the control variable, a proportional-integral-differential control algorithm, and a propofol target-controlled infusion system as (lie control

  15. A substitution method to improve completeness of events documentation in anesthesia records.

    Science.gov (United States)

    Lamer, Antoine; De Jonckheere, Julien; Marcilly, Romaric; Tavernier, Benoît; Vallet, Benoît; Jeanne, Mathieu; Logier, Régis

    2015-12-01

    AIMS are optimized to find and display data and curves about one specific intervention but is not retrospective analysis on a huge volume of interventions. Such a system present two main limitation; (1) the transactional database architecture, (2) the completeness of documentation. In order to solve the architectural problem, data warehouses were developed to propose architecture suitable for analysis. However, completeness of documentation stays unsolved. In this paper, we describe a method which allows determining of substitution rules in order to detect missing anesthesia events in an anesthesia record. Our method is based on the principle that missing event could be detected using a substitution one defined as the nearest documented event. As an example, we focused on the automatic detection of the start and the end of anesthesia procedure when these events were not documented by the clinicians. We applied our method on a set of records in order to evaluate; (1) the event detection accuracy, (2) the improvement of valid records. For the year 2010-2012, we obtained event detection with a precision of 0.00 (-2.22; 2.00) min for the start of anesthesia and 0.10 (0.00; 0.35) min for the end of anesthesia. On the other hand, we increased by 21.1% the data completeness (from 80.3 to 97.2% of the total database) for the start and the end of anesthesia events. This method seems to be efficient to replace missing "start and end of anesthesia" events. This method could also be used to replace other missing time events in this particular data warehouse as well as in other kind of data warehouses. PMID:25634428

  16. The effect of early ambulation on the incidence of neurological complication after spinal anesthesia with lidocaine

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    Reihanak Talakoub

    2015-01-01

    Full Text Available Background: Transient neurological symptoms (TNS, was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%. Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithotomy positions. Patients were randomly divided into early ambulation group (Group A who were asked to start walking as soon as the anesthesia was diminished or to the late ambulation group (Group B who walked after at least 12 h bedridden. Participants were contacted 2 days after spinal anesthesia to assess any type of pain at surgical or anesthesia injection site, muscle weakness, fatigue, vertigo, nausea, vomiting, headache, and difficult urination or defecation. Results: Four subjects (13.3% in Group A and two patients (6.7% in Group B had pain at anesthesia injection site (P = 0.019. Fourteen patients in Group A (46.7% and six patients in Group B (20% had post-dural puncture headache (P = 0.014. Participants in Group B reported difficult urination more than Group A (P = 0.002. there were not statistically significant differences between two groups regarding frequency of fatigue, muscle weakness, vertigo, nausea, vomiting, difficult defecation, paresthesia, and the mean of visual analogue scale at the surgical site. Conclusion: Early ambulation after spinal anesthesia with lidocaine did not increase the risk of neurologic complication.

  17. Effect of ondansetron in preventing postoperative nausea and vomiting under different conditions of general anesthesia: A preliminary, randomized, controlled study

    Science.gov (United States)

    Zhang, Dengxin; Shen, Zhiyun; You, Jie; Zhu, Xiaolian

    2013-01-01

    Methods Two hundred and forty patients were randomly allocated into six groups: Group I, anesthesia was maintained with sevoflurane; Group II, anesthesia was maintained with sevoflurane and 8 mg of ondansetron; Group III, anesthesia was maintained with propofol; Group IV, anesthesia was maintained with propofol and 8 mg of ondansetron; Group V, anesthesia was maintained with sevoflurane and propofol; Group VI, anesthesia was maintained with sevoflurane combined with propofol and 8 mg of ondansetron. Results We found that the incidence of vomiting was lower in group II (17.5%), group IV (7.5%), and group VI (10%) compared with group I (55%), group III (27.5%), and group V (30%), respectively (P < 0.05). The incidence of vomiting was also lower in group III (27.5%) and group V (30%) when compared with group I (55%) (P < 0.05). The incidence of nausea was 55% in group I, 42.5% in group II, 30% in group III, 27.5% in group IV, 30% in group V, and 30% in group VI. Groups III and V had a lower incidence of nausea than group I (P < 0.05). Conclusions We conclude that compared with sevoflurane anesthesia alone, anesthesia with either propofol alone or propofol combined with sevoflurane resulted in a reduced incidence of vomiting and nausea during the first 24 h after surgery. Administration of ondansetron effectively reduced the incidence of vomiting but not that of nausea for all three types of general anesthesia. PMID:23441598

  18. Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

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    Paulo Gustavo Kotze

    2011-09-01

    Full Text Available There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender. The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334. The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79 in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51 in the second - 69.27% difference between them (pNão há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero. A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334. O custo médio do procedimento anestésico no primeiro grupo

  19. A reappraisal of local anesthesia for prostate brachytherapy

    International Nuclear Information System (INIS)

    Purpose: Faced with rapidly increasing patient numbers, the authors adopted and modified a technique to perform prostate implants under local anesthesia in a radiation oncology facility. Our reasons for assembling the current report detailing 20 consecutive, unselected patients are to show how patients tolerate brachytherapy without the use of sedatives, to provide more technical detail regarding the procedure's practical aspects, and to summarize the time needed to complete its components. Materials and methods: No pre-operative medication is given. The patient is placed in the lithotomy position, using stirrups mounted on the end of the simulator table. A 5-cmx5-cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 3--5 cm3 of 0.5% lidocaine, using a 25-gauge 1.5-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, of the pelvic floor are anesthetized by injecting 5 cm3 lidocaine solution with approximately 16 passes of a 25-gauge 1.5-inch needle entering perpendicular to the skin surface. The transrectal ultrasound (TRUS) probe of a Siemens SONOLINE Prima ultrasound machine (6.0 MHz) and a Winston-Barzell stepper unit is next positioned to reproduce the planning images and a 3.5-inch, 22-gauge spinal needle is inserted into the peripheral and a few central tracks. About 0.5 cm3 of lidocaine solution is injected into each intraprostatic track, as the needle is slowly advanced. Finally, a 7-inch 22-gauge spinal needle inserted through the skin via a 3.5-inch 18-gauge needle, is used to anesthetize to the base of the prostate under TRUS and fluoroscopic guidance. Seed placement is done with a Mick ApplicatorTM, inserting and loading one needle at a time. The number of seeds placed ranged from 60 to 118 (average: 87) and the number of needles used ranged from 14 to 20 (average: 18). For the purpose of this study, prior to walking to the simulator suite, patients were asked to rate the

  20. The impact of anesthesia providers on major morbidity following screening colonoscopies

    Directory of Open Access Journals (Sweden)

    Lubarsky DA

    2015-05-01

    Full Text Available David A Lubarsky,1 Jason R Guercio,2 John W Hanna,3,4 Maria T Abreu,5 Qianli Ma,3 Claudia Uribe,3 David J Birnbach,1,6 David R Sinclair,1 Keith A Candiotti1 1Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami – Miller School of Medicine, Miami, FL, USA; 2Department of Anesthesiology, Duke University, Durham, NC, USA; 3Humana, Comprehensive Health Insights, Miami, FL, USA; 4University of Miami – Miller School of Medicine, Miami, FL, USA; 5Department of Medicine, Division of Gastroenterology, University of Miami – Miller School of Medicine, Miami, FL, USA; 6Department of Public Health Sciences, University of Miami – Miller School of Medicine, Miami, FL, USA Background and aims: Few studies evaluate the impact of anesthesia providers during procedures, such as colonoscopy, on low-risk patients. The objective of this study was to compare the effect of anesthesia providers on several outcome variables, including major morbidity, following screening colonoscopies. Methods: A propensity-matched cohort study of 14,006 patients who enrolled with a national insurer offering health maintenance organization (HMO, preferred provider organization (PPO, and Medicare Advantage plans for a screening colonoscopy between July 1, 2005 and June 30, 2007 were studied. Records were evaluated for completion of the colonoscopy, new cancer diagnosis (colon, anal, rectal within 6 months of the colonoscopy, new primary diagnosis of myocardial infarction (MI, new primary diagnosis of stroke, hospital admission within 7 days of the colonoscopy, and adherence to guidelines for use of anesthesia providers. Results: The presence of an anesthesia provider did not affect major morbidity or the percent of completed exams. Overall morbidity within 7 days was very low. When an anesthesia provider was present, a nonsignificant trend toward greater cancer detection within 6 months of the procedure was observed. Adherence to national

  1. A quest to increase safety of anesthetics by advancements in anesthesia monitoring: scientometric analysis

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    Vlassakov KV

    2015-05-01

    Full Text Available Kamen V Vlassakov, Igor Kissin Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Abstract: The aim of this study was to assess progress in the field of anesthesia monitoring over the past 40 years using scientometric analysis. The following scientometric indexes were used: popularity indexes (general and specific, representing the proportion of articles on either a topic relative to all articles in the field of anesthetics (general popularity index, GPI or the subfield of anesthesia monitoring (specific popularity index, SPI; index of change (IC, representing the degree of growth in publications on a topic from one period to the next; and index of expectations (IE, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000 biomedical journals covered by PubMed. Publications on 33 anesthesia-monitoring topics were assessed. Our analysis showed that over the past 40 years, the rate of rise in the number of articles on anesthesia monitoring was exponential, with an increase of more than eleven-fold, from 296 articles over the 5-year period 1974–1978 to 3,394 articles for 2009–2013. This rise profoundly exceeded the rate of rise of the number of articles on general anesthetics. The difference was especially evident with the comparison of the related GPIs: stable growth of the GPI for anesthesia monitoring vs constant decline in the GPI for general anesthetics. By the 2009–2013 period, among specific monitoring topics introduced after 1980, the SPI index had a meaningful magnitude (≥1.5 in 9 of 24 topics: Bispectral Index (7.8, Transesophageal Echocardiography (4.2, Electromyo­graphy (2.8, Pulse Oximetry (2.4, Entropy (2.3, Train-of-four (2.3, Capnography (1.9, Pulse Contour (1.9, and Electrical Nerve Stimulation for neuromuscular monitoring (1.6. Only one of these topics (Pulse

  2. Managing anesthesia for cesarean section in obese patients: current perspectives.

    Science.gov (United States)

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  3. Tetrodotoxin-Bupivacaine-Epinephrine Combinations for Prolonged Local Anesthesia

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    Christina Bognet

    2011-12-01

    Full Text Available Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL solutions, with or without epinephrine 5 µg/mL (1:200,000 in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001 or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001. Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia.

  4. Emergence from general anesthesia and the sleep-manifold

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    Darren Fletcher Hight

    2014-08-01

    Full Text Available The electroencephalogram (EEG during the re-establishment of consciousness after general anesthesia and surgery varies starkly between patients. Can the EEG during this emergence period provide a means of estimating the underlying biological processes underpinning the return of consciousness? Can we use a model to infer these biological processes from the EEG patterns? A frontal EEG was recorded from 84 patients. Ten patients were chosen for state-space analysis. Five showed archetypal emergences; which consisted of a progressive decrease in alpha power and increase peak alpha frequency before return of responsiveness. The five non-archetypal emergences showed almost no spectral EEG changes (even as the volatile general anesthetic decreased and then an abrupt return of responsiveness. We used Bayesian methods to estimate the likelihood of an EEG pattern corresponding to the position of the patient on a 2-dimensional manifold in a state space of excitatory connection strength vs change in intrinsic resting neuronal membrane conductivity. We could thus visualize the trajectory of each patient in the state-space during their emergence period. The patients who followed an archetypal emergence displayed a very consistent pattern; consisting of progressive increase in conductivity, and a temporary period of increased connection strength before return of responsiveness. The non-archetypal emergence trajectories remained fixed in a region of phase space characterized by a relatively high conductivity and low connection strength throughout emergence. This unexpected progressive increase in conductivity during archetypal emergence may be due to an abating of the surgical stimulus during this period. Periods of high connection strength could represent forays into dissociated consciousness, but the model suggests all patients reposition near the fold in the state space to take advantage of bi-stable cortical dynamics before transitioning to consciousness.

  5. Management of comorbidities in ambulatory anesthesia: a review

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    Dabu-Bondoc S

    2015-06-01

    Full Text Available Susan Dabu-Bondoc, Kirk Shelley Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, USAAbstract: Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these “walking wounded”. The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.Keywords: ambulatory surgery, medical comorbidities, diabetes, coronary artery disease, respiratory disease, obesity

  6. Rectal premedication in pediatric anesthesia: midazolam versus ketamine

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    Moshirian N

    2008-06-01

    Full Text Available Background: Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The rectal route is one of the most commonly accepted means of drug administration. The aim of our study was to investigate and compare the efficacy of rectally administered midazolam versus that of ketamine as a premedication in pediatric patients.Methods: We performed a prospective randomized double-blinded clinical trial in 64 children, 1 to 10 years of age, randomly allocated into two groups. The midazolam group received 0.5 mg/kg rectal midazolam and the ketamine group received 5 mg/kg rectal ketamine. The preoperative sedation scores were evaluated on a three-point scale. The anxiolysis and mask acceptance scores were evaluated separately on a four-point scale, with ease of parental separation, based on the presence or lack of crying, evaluated on a two-point scale. Results: Neither medication showed acceptable sedation (>75%, with no significant difference in sedation score between the two groups (P=0.725. Anxiolysis and mask acceptance using either midazolam or ketamine were acceptable, with  midazolam performing significantly better than ketamine (P=0.00 and P=0.042, respectively. Ease of parental separation was seen in both groups without significant difference (P=0.288 and no major adverse effects, such as apnea, occurred in either group.Conclusions: Rectal midazolam is more effective than ketamine in anxiolysis and mask acceptance. Although they both can ease separation anxiety in children before surgery, we found neither drug to be acceptable for sedation.

  7. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P Pulmonary perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  8. THORACIC EPIDURAL ANESTHESIA FOR MODIFIED RADICAL MASTECTOMY-IN TYPE2 DIABETES MELLITUS PATIENT

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    Vishwanath R

    2014-12-01

    Full Text Available Modified radical mastectomy (MRM, the standard oncologic surgical procedure of the carcinoma of breast is routinely performed under general anesthesia. Carcinoma breast patients are considered to be at high risk for anesthesia due to high possibility of perioperative complications and mortality when associated with long standing type 2 Diabetes Mellitus (DM with other co morbidities. Cardiac complications due to macro vascular and micro vascular involvement can pose a real threat. Here we present a case report of successful perioperative management of modified radical mastectomy only with thoracic epidural anesthesia (TEA in a case of carcinoma breast with long standing type 2 DM and hypertension. A 71year old female, a known case of DM since 7years with co morbidity; hypertension having a carcinoma breast was scheduled for modified radical mastectomy. Continuous epidural anesthesia was administered at T4-5 level. Local anesthetic supplementation titrated as per the demands of surgery and good postoperative analgesia maintained for 48 hours. Long standing DM with hypertension can lead to perioperative morbidity and mortality due to cardiac complications. However, Thoracic epidural anesthesia (TEA reduces cardiac and sympathetic activity and thereby improves perioperative function of vital organs and reduces postoperative morbidity and mortality. The procedure can lead to prompt recovery with additional benefit of prolonged post-operative analgesia. TEA proved to be an excellent anesthetic technique for MRM in patient with long standing DM.

  9. Response of left ventricular ejection fraction to recovery from general anesthesia: measurement by gated radionuclide angiography

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    To test the hypothesis that, after anesthesia for noncardiac surgical procedures, the increased cardiac work during recovery induces wall motion and ejection fraction (EF) abnormalities in patients with mild angina pectoris, gated radionuclide angiography was performed in patients undergoing simple cholecystectomy under narcotic-relaxant general anesthesia. The ejection fraction was determined during anesthesia at the end of surgery, and then determined 3 min and 3 hr after extubation. A new angiography was performed 24 hr later, and a myocardial scintigraphy (Thallium 201) was performed during infusion of the coronary vasodilator, dipyridamole. In the first part of the investigation, eight patients without coronary artery disease (CAD) (group 1) and 20 patients with mild angina (group 2) were studied. In the second part of the study, seven patients (group 3) with mild angina pectoris received an intravenous infusion of 0.4 microgram X kg-1 X min-1 of nitroglycerin started before surgery and gradually decreased 4 hr after extubation. In group 1, EF remained unchanged at recovery. In contrast in group 2, EF responded abnormally to recovery: EF decreased from 55% during anesthesia to 45% 3 min after extubation (P less than 0.001). Patients in group 3, who received intravenous nitroglycerin, showed no change of EF at recovery. This study demonstrates that recovery from general anesthesia causes abnormalities in left ventricular function in patients suffering from CAD. These abnormalities are prevented by prophylactic intravenous nitroglycerin

  10. Response of left ventricular ejection fraction to recovery from general anesthesia: measurement by gated radionuclide angiography

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    Coriat, P.; Mundler, O.; Bousseau, D.; Fauchet, M.; Rous, A.C.; Echter, E.; Viars, P.

    1986-06-01

    To test the hypothesis that, after anesthesia for noncardiac surgical procedures, the increased cardiac work during recovery induces wall motion and ejection fraction (EF) abnormalities in patients with mild angina pectoris, gated radionuclide angiography was performed in patients undergoing simple cholecystectomy under narcotic-relaxant general anesthesia. The ejection fraction was determined during anesthesia at the end of surgery, and then determined 3 min and 3 hr after extubation. A new angiography was performed 24 hr later, and a myocardial scintigraphy (Thallium 201) was performed during infusion of the coronary vasodilator, dipyridamole. In the first part of the investigation, eight patients without coronary artery disease (CAD) (group 1) and 20 patients with mild angina (group 2) were studied. In the second part of the study, seven patients (group 3) with mild angina pectoris received an intravenous infusion of 0.4 microgram X kg-1 X min-1 of nitroglycerin started before surgery and gradually decreased 4 hr after extubation. In group 1, EF remained unchanged at recovery. In contrast in group 2, EF responded abnormally to recovery: EF decreased from 55% during anesthesia to 45% 3 min after extubation (P less than 0.001). Patients in group 3, who received intravenous nitroglycerin, showed no change of EF at recovery. This study demonstrates that recovery from general anesthesia causes abnormalities in left ventricular function in patients suffering from CAD. These abnormalities are prevented by prophylactic intravenous nitroglycerin.

  11. High thoracic epidural anesthesia in cardiac surgery: risk factors for arterial hypotension.

    Science.gov (United States)

    Casalino, Stefano; Mangia, Fabio; Stelian, Edmond; Novelli, Eugenio; Diena, Marco; Tesler, Ugo F

    2006-01-01

    There is an interest in the use of high thoracic epidural anesthesia in cardiac surgery, because experimental and clinical studies have suggested that central neuroaxial blockade attenuates the response to surgical stress and improves myocardial metabolism and perioperative analgesia-thus enabling earlier extubation and a smoother postoperative course. Matters of major concern in the adoption of high thoracic epidural anesthesia in cardiac surgery are neurologic injury secondary to neuroaxial hematoma and hypotension secondary to sympatholysis. The risk associated with possible neuraxial hematoma caused by high thoracic epidural anesthesia has been thoroughly investigated and largely discounted, but scant attention has been devoted to the onset of hypotensive episodes in the same setting. We analyzed the hypotensive episodes that occurred in a series of 144 patients who underwent on-pump cardiac surgery procedures. Among the patient variables that we tested in a multivariate logistic-regression model, only female sex was found to be significantly correlated with hypotension. In order to decrease the incidence and severity of hypotensive episodes resulting from anesthetic blockade, anesthesiologists need to monitor, with special care, women patients who are under high thoracic epidural anesthesia. Further studies are needed in order to determine why women undergoing open heart surgery under high thoracic epidural anesthesia are at a relatively greater risk of hypotension. PMID:16878616

  12. [Anesthesia in obstetrics: Tried and trusted methods, current standards and new challenges].

    Science.gov (United States)

    Kranke, P; Annecke, T; Bremerich, D H; Hanß, R; Kaufner, L; Klapp, C; Ohnesorge, H; Schwemmer, U; Standl, T; Weber, S; Volk, T

    2016-01-01

    Obstetric analgesia and anesthesia have some specific aspects, which in particular are directly related to pathophysiological alterations during pregnancy and also to the circumstance that two or even more individuals are always affected by complications or therapeutic measures. This review article deals with some evergreens and hot topics of obstetric anesthesia and essential new knowledge on these aspects is described. The article summarizes the talks given at the 16th symposium on obstetric anesthesia organized by the Scientific Committee for Regional Anaesthesia and Obstetric Anaesthesia within the German Society of Anaesthesiology. The topics are in particular, special features and pitfalls of informed consent in the delivery room, challenges in education and training in obstetric anesthesia, expedient inclusion of simulation-assisted training and further education on risk minimization, knowledge and recommendations on fasting for the delivery room and cesarean sections, monitoring in obstetric anesthesia by neuraxial and alternative procedures, the possibilities and limitations of using ultrasound for lumbal epidural catheter positioning in the delivery room, recommended approaches in preparing peridural catheters for cesarean section, basic principles of cardiotocography, postoperative analgesia after cesarean section, the practice of early bonding in the delivery room during cesarean section births and the management of postpartum hemorrhage. PMID:26745995

  13. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  14. [Effects of epidural analgesia combined with general anesthesia on hemodynamics during neck surgery].

    Science.gov (United States)

    Arakawa, M; Amemiya, N; Nagai, K; Kato, S; Goto, F

    1993-10-01

    The aim of the present study was to investigate the effect of epidural analgesia combined with general anesthesia on hemodynamics. Thirty patients undergoing surgery for the treatment of cancer of the neck were studied. The patients were divided into two groups of those who received epidural analgesia combined with general anesthesia group (Group 1) and those with general anesthesia alone (Group 2). Blood pressure was not different between the groups. But heart rate and rate pressure products in Group 1 were significantly lower than those of Group 2. CVP in Group 1 increased significantly to 10.1 +/- 2.9 mmHg during surgery from 6.8 +/- 1.8 mmHg at the beginning of the surgery. There was no difference in intraoperative blood loss and the amount of fluid infused between the two groups. These results suggest that epidural anesthesia combined with general anesthesia is effective to stabilize hemodynamics during cervical surgery, but we have to be careful about using local anesthetics during long cervical procedures, because it increases CVP which might result from the depression of cardiac function. PMID:8230698

  15. Response to neonatal anesthesia: effect of sex on anatomical and behavioral outcome.

    Science.gov (United States)

    Rothstein, S; Simkins, T; Nuñez, J L

    2008-04-01

    Numerous studies have documented the consequences of exposure to anesthesia in models of term and post-term infants, evaluating the incidence of cell loss, physiological alterations and cognitive dysfunction. However, surprisingly few studies have investigated the effect of anesthetic exposure on outcomes in newborn rodents, the developmental equivalent of premature human infants. This is critical given that one out of every eight babies born in the United States is premature, with an increased prevalence of surgical procedures required in these individuals. Also, no studies have investigated if the genetic sex of the individual influences the response to neonatal anesthesia. Using the newborn rat as the developmental equivalent of the premature human, we documented the effect of a single bout of exposure to either the inhalant isoflurane or the injectable barbiturate phenobarbital on hippocampal anatomy, hippocampal dependent behavioral performance and normal developmental endpoints in male and female rats. While both forms of anesthesia led to significant decrements in cognitive abilities, along with a significant reduction in volume and neuron number in the hippocampus in adulthood, the decrements were significantly greater in males than in females. Interestingly, the deleterious effects of anesthesia were manifest on developmental measures including surface righting and forelimb grasp, but were not evident on basic physiological parameters including body weight or suckling. These findings point to the hazardous effects of exposure to anesthesia on the developing CNS and the particular sensitivity of males to deficits. PMID:18329814

  16. Status of problem based learning in postgraduate anesthesia teaching: A cross-sectional survey

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    Geetanjali Chilkoti

    2015-01-01

    Full Text Available Background: Anesthesia is a specialized branch of medicine with a very narrow margin of error. Incorporation of problem-based learning (PBL in anesthesia post-graduate (PG teaching enhances the critical thinking and problem-solving skills. It also helps in developing a broader prospective of clinical case scenarios. Case based discussions (CBD are most widely practiced out of all PBL methods in anesthesia PG teaching. Materials and Methods: We conducted an anonymous questionnaire based, cross-sectional survey among 62 anesthesia residents from various medical institutions in a city of Delhi, India. We aimed to assess the current status of PBL by assessing the student satisfaction with CBD in anesthesia PG teaching, educational objectives accomplished with CBD and effectiveness of teaching curriculum in PG teaching with suggested modifications, if any. Result and Conclusion: We observed that CBD is lacking in many important key areas of PBL e.g., formulation of objectives, communication on the content and direction of PBL, facilitation skills, supplementation of inadequacies of CBD. However, CBD seems to be a valid method of PBL in terms of the educational objectives accomplished with it but increased motivation for learning is required. Majority of the students felt that PG teaching curriculum should be centralized, with increased emphasis on open interactive sessions regarding its effectiveness.

  17. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P mechanical ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  18. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P Pulmonary perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P mechanical ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  19. Neurocognitive Adverse Effects of Anesthesia in Adults and Children: Gaps in Knowledge.

    Science.gov (United States)

    Ward, Christopher G; Eckenhoff, Roderic G

    2016-07-01

    Numerous preclinical and clinical studies investigating the neurodevelopmental and neurocognitive effects of exposure to anesthesia and the combination of anesthesia and surgery have demonstrated histopathological and both temporary and long-term cognitive and behavioral effects at the extremes of the human age spectrum. Increasing coverage in the lay press for both our youngest and oldest patient populations has led to heightened concerns regarding the potential harmful side effects of almost all commonly used anesthetic drug regimens. Although the majority of information regarding anesthetic risks in the developing brain derives from preclinical work in rodents, research involving the aged brain has identified a well-defined postoperative cognitive phenotype in humans. While preclinical and clinical data appear to support some association between anesthesia and surgery and the development of detrimental cognitive changes in both the developing and the aged brain, correlation between anesthesia and surgery and poor neurological outcomes does not imply causation. Given this information, no single anesthetic or group of anesthetics can be recommended over any other in terms of causing or preventing negative neurocognitive outcomes in either population. This review summarizes the growing body of preclinical and clinical literature dedicated to the detrimental effects of anesthesia on both the developing and the aging brain. PMID:27098249

  20. Evaluation of latent period of temperature sensitivity in traditional and unilateral spinal anesthesia

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    Lakhin R.E.

    2015-09-01

    Full Text Available Objective: evaluation of the differences in the level of temperature, sensory and motor blockade during the various techniques of spinal anesthesia. Materials and Methods. Prospectively the randomized study included 70 patients. In the group with conventional spinal anesthesia (n=35 15mg of bupivacaine injected quickly. In the group with unilateral spinal anesthesia (n=35 7.5mg of bupivacaine administered slowly, at a rate of 1 ml per minute. We studied the level of temperature and time, sensory and motor blockade. The data are statistically processed. Results. Reduced thermal sensitivity recorded in an average of 48 seconds as a unilateral spinal anesthesia group and the control group. Subarachnoid administration of 7.5 mg of hyperbaric bupivacaine resulted in the development of a complete motor blockade underlying lower extremity in only 16 patients (45.7%. Conclusion. Using lower dosages of bupivacaine for unilateral spinal anesthesia lowers the threshold concentration of the local anesthetic in the subarachnoid space, resulting in slower motor neuron blockade and it is not total in more than 50% of cases.